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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414567
Report Date: 08/26/2021
Date Signed: 08/26/2021 04:02:34 PM

Document Has Been Signed on 08/26/2021 04:02 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:A PLACE TO GROWFACILITY NUMBER:
434414567
ADMINISTRATOR:FLANDA TERNIANFACILITY TYPE:
850
ADDRESS:4115 JACKSOL DRIVE BUILDING 2TELEPHONE:
(408) 265-2994
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kalin Tiernan, AdministratorTIME COMPLETED:
04:12 PM
NARRATIVE
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#2 Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection at the facility today. LPA met with Kalin Tiernan, Administrator and Vinda Tarverdian, Assistant Director and discussed the purpose of the visit.

LPA toured the facility inside and outside with the Assistant Director. Facility's License, Notification of Parents’ Rights, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist, Activities schedule and Menu were observed to be posted. The center's operating hours are Monday through Friday 6:30 AM to 6:00 PM.

The classrooms and activity areas were observed to be clean and in good order. Furniture and play equipment were observed to be age appropriate and in good condition. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Children's restroom is clean and in good operating condition. The center has a fire alarm system, fire extinguishers and smoke detectors were observed in the facility. Director stated that facility does not have weapons and ammunition on the premises. Trash cans for solid wastes have tight-fitting covers on.

The playground and outdoor area is surrounded by appropriate fencing and the surfaces are safe for the children. The outdoor and play equipment are age appropriate and in good condition. There are sufficient resilient materials in the playground area. There are no bodies of water observed.

The kitchen area is clean and free of litter. All food and beverages that require refrigeration are stored in covered containers in the refrigerator.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: A PLACE TO GROW
FACILITY NUMBER: 434414567
VISIT DATE: 08/26/2021
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Copies of children's roster were obtained. Ten (10) children's records were reviewed which include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment and Immunization.

Five (5) staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record, CPR/First Aid, Mandated Reported Training, Lead Poisoning Prevention certification and required education and training.

Sign in and sign out records and fire/disaster drill logs were reviewed. Disaster drills are conducted every month. School has an electronic sign in and out system.

LPA reviewed with director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources on Regulations, Adoptions of new laws, pay annual fees etc.

Director stated that they a not planning to provide (Incidental Medical Services) IMS at this time.

No deficiencies cited during today's inspection. A copy of this report was provided to the director.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
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