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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416977
Report Date: 06/26/2023
Date Signed: 06/26/2023 04:13:06 PM

Document Has Been Signed on 06/26/2023 04:13 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:I GROW LEARNING ACADEMYFACILITY NUMBER:
434416977
ADMINISTRATOR:SVITLANA BUTENKOFACILITY TYPE:
850
ADDRESS:1063 FEWTRELL DRIVETELEPHONE:
(650) 224-6693
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 53TOTAL ENROLLED CHILDREN: 56CENSUS: 42DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Svitlana ButenkoTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Ashley Lopez and Marilou Monico met with Site Director, Svitlana Butenko , for an unannounced Required - 1 Year Inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 8:00AM to 6:00PM. The facility is licensed to serve children ages 2 years to 6 years old.

LPAs toured the indoor and outdoor areas. The last fire drill was conducted on 6/7/2023. The facility has current children's roster and copy was provided to LPAs during the inspection. Cleaning products, disinfectants, sharp objects were stored in laundry room and kitchen, which is inaccessible to children. The facility is clean, furniture and equipment were observed to be age appropriate and in good condition. The bathrooms for children are clean, sanitary, and operable. LPAs observed three toilets and three sinks in Room #2, and two toilets and two sinks in Room #3, and one sink in Playground 1 available for the children.

The center provides breakfast, lunch, and afternoon snack to the children. The kitchen is equipped with refrigerator, stove, oven, dishwashers, microwave and a sink with hot and cold running water. LPAs advised director that children over 2 years should have 1%, lowfat, or nonfat milk. Drinking water is available for the children indoor via water dispenser and disposable cups. LPAs observed trash cans with tight fitting covers for the disposable of solid wastes. The facility has 3A40BC fire extinguishers in the facility and a working smoke and carbon monoxide detectors.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: I GROW LEARNING ACADEMY
FACILITY NUMBER: 434416977
VISIT DATE: 06/26/2023
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The playgrounds are surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided by trees, canopies, patio, and building overhang. Drinking water is readily available for the children outdoor via water dispenser and disposable cups. There are climbing structures and swings in Playground 1 and 2 with synthetic grass as resilient material under and around the structure. LPAs did not observe any bodies of water. Svitlana stated that there are no weapons or firearms on the premises.

LPAs reviewed 10 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Parent Right's Receipt, Personal Rights, and Health History. All files were complete with the required documents.

LPAs reviewed 9 staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. While reviewing the staff files, LPAs observed teacher files missing immunizations and education. LPAs reminded Site Director that the Mandated Reporter Training shall be renewed by all staff every two years. LPAs observed that at least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility does not provide Incidental Medical Services (IMS) at the moment. The director states that presently there are no children in the daycare that require medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: I GROW LEARNING ACADEMY
FACILITY NUMBER: 434416977
VISIT DATE: 06/26/2023
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Site Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

The facility completed the lead testing prior to their deadline. LPAs obtained copies of the Lead report from the director.

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


As a result of this inspection, deficiencies are cited on the following page LIC 809D.

Exit interview conducted and report was reviewed with Site Director, Svitlana Butenko

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2023 04:13 PM - It Cannot Be Edited


Created By: Ashley Lopez On 06/26/2023 at 03:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: I GROW LEARNING ACADEMY
FACILITY NUMBER: 434416977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, there are 3 out of 9 staff members that need proof of immunizations for MMR and Pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2023
Plan of Correction
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Director Svitlana Butenko stated she will send proof of staff #2, staff #6, staff #8 immunizations for MMR and Pertussis to licensing by 7/10/23.
Type B
Section Cited
CCR
101216.1(b)(1)
Teacher Qualifications and Duties
(b) Prior to employment, a teacher shall meet the requirements of (b)(1) or (b)(2) below: (1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below; or shall have obtained a Child Development Assistant Permit issued by the California Commission on Teacher Credentialing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Staff #2, #5, and #8 are missing units to be a qualified preschool teacher. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2023
Plan of Correction
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Svitlana stated that she will submit proof of enrollment for the three staff by 07/03/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Ashley Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023


LIC809 (FAS) - (06/04)
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