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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417100
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:01:38 AM

Document Has Been Signed on 09/20/2023 11:01 AM - 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:ACTION DAY NURSERIES & PRIMARY PLUS INCFACILITY NUMBER:
434417100
ADMINISTRATOR:JAMIE FERGUSONFACILITY TYPE:
850
ADDRESS:2021 LINCOLN AVENUETELEPHONE:
(408) 244-1968
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 25TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Jamie FergusonTIME COMPLETED:
11:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz an unannounced case management inspection during another visit and met with Jamie Ferguson, Director. Director provided a guided tour to LPA of indoor and outdoor areas of the facility. LPA observed that the facility is not operating, no preschool children or staff observed during today's inspection. Director informed LPA that the facility has not had any children enrollment since it was granted a license. Director stated that Action Day Management decided to have the building improved before accepting new enrollment of preschool children. LPA informed Director that the Department must be informed of any proposed changes prior to construction alterations to be done to the facility. LPA also advised for Director to notify the Department for any facility closures since facility has an active license. LPA provided Director with LIC9211 Request for Inactive Child Care License Status form.

A deficiency was cited, appeal rights were given to Director, See (809-D). Exit interview was conducted with Jamie Ferguson, Director.

A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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Document Has Been Signed on 09/20/2023 11:01 AM - It Cannot Be Edited


Created By: Janette Cruz On 09/20/2023 at 10:19 AM
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: ACTION DAY NURSERIES & PRIMARY PLUS INC
FACILITY NUMBER: 434417100

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2023
Section Cited
CCR
101237(a)

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101237 Alterations to Existing Buildings or New Facilities
(a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).
This requirement is not met as evidenced by:
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Licensee will submit a statement of understanding of Title 22 regulation violated and provide a detailed plan and information regarding alterations being done in the facility's physical plant.
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Based on observation and interview, Licensee did not comply to this section cited above. LPA observed that Licensee has made construction alterations in the facility without notifying the Department which poses a potential health, safety or personal rights risk to persons in care.
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023


LIC809 (FAS) - (06/04)
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