434400032-8-22-2024-07-CC-MSMS-D8DTU8-20240822150155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400032
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:01:59 PM

Document Has Been Signed on 08/22/2024 03:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CALIFORNIA YOUNG WORLD AT SAN MIGUEL		FACILITY NUMBER:	434400032
ADMINISTRATOR/ DIRECTOR:	EMERSON VENTURA		FACILITY TYPE:	840
ADDRESS:	777 SAN MIGUEL AVENUE		TELEPHONE:	(408) 738-1385
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 29	CENSUS: 24	DATE:	08/22/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Emerson Ventura		TIME VISIT/ INSPECTION COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mel Matos met with Emerson Ventura, Director, for an unannounced Required - 3 year inspection. LPA toured the indoor and outdoor space of the Facility during today's inspection. The Facility is licensed to serve a maximum of forty two (42) school age children ages K to 5th grade in Portable 1 (P1) & Room P4 on the campus of San Miguel Elementary School. Hours of operation are: 6:30 AM-8 AM & 11:20 AM- 6 PM Monday to Friday during the calendar school year and 6:30 AM to 6 PM Monday to Friday during school breaks. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. LPA reviewed six children's and two staff files (1 director and 1 teacher) during today's inspection. Each child's file reviewed contains the required documents; including the Information and Emergency Information form (LIC 700) and immunization records. All staff files reviewed contain the required documents; including transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on May 30, 2024. Director & one teacher has current CPR and First Aid certifications on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed twenty four (24) school age children with the Director and one teacher in the Facility during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director is aware of the required sign in and sign out procedures for school age children who arrive on their own. Director states that all school age children are picked up by their parent(s)/guardian(s) and no children are allowed to leave the Facility on their own. Director understands that children shall be visually supervised at all times. Room P4 was not in use during today's inspection. LPA notes that the Facility is Title 5 funded and thus Title 5 ratios apply. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. LPA observed that Portable 1 (P1) and Room P4 are clean and safe for all children, staff, and visitors. The Facility has adequate ventilation, including central air conditioning/heating. LPA observed all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in Portable 1 (P1) and Room P4 and in the outdoor playground area via water fountains and reusable plastic cups/water bottles.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CALIFORNIA YOUNG WORLD AT SAN MIGUEL	FACILITY NUMBER: 434400032
	VISIT DATE: 08/22/2024

NARRATIVE

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Director states that a third party cleaning service provides cleaning services Monday through Friday in the evenings. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff stall not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. The Facility provides breakfast and snacks during the calendar school year and breakfast, snacks, and lunch during school breaks. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. LPA observed solid waste containers with tight-fitting lids in Portable 1 (P1) and Room P4 and outdoors. Cleaning supplies are inaccessible to the children. Director states that there are no poisons in the Facility. LPA observed a complete First Aid kit in the Facility. Director understands that smoking is not allowed on the Facility premises.

Director states that the Facility does not administer any medications at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is a secure play structure that is age appropriate for the school age children. Shade is provided by trees, canopy, umbrellas, and building overhangs. There is sufficient resilient materials in the outdoor playground area (wood chips). LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.

Emerson Ventura, Director, was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Director, Emerson Ventura. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

LIC809 (FAS) - (06/04)

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