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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413304
Report Date: 06/21/2023
Date Signed: 06/21/2023 02:52:37 PM

Document Has Been Signed on 06/21/2023 02:52 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:COMMUNITY BRIDGES EED HIGHLANDS PARK CENTERFACILITY NUMBER:
444413304
ADMINISTRATOR:ISIS GREESPANFACILITY TYPE:
850
ADDRESS:8500 HIGHWAY 9TELEPHONE:
(831) 336-2857
CITY:BEN LOMONDSTATE: CAZIP CODE:
95005
CAPACITY: 24TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jamie Delaney & Lisa Hindman HolbertTIME COMPLETED:
03:02 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Supervisor, Jamie Delaney, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by Jamie and toured both indoors and outdoors during the inspection. Upon arrival, there were seven preschool-age children present with two staff members, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 8:00AM-4:00PM.

LPA reviewed digital sign-in/out sheets and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed using KinderSystem with full legal signature and time of day. The last fire/disaster drill was conducted on 3/21/2023, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher (last serviced: 8/2021) and functioning carbon monoxide detector. LPA advised annual servicing of fire extinguishers and observed the facility has a built in fire detection system. Jamie states that there are currently no children in care who require Incidental Medical Services and no medication is administered at this time. There are no weapons or firearms on the premises.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 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 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: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER
FACILITY NUMBER: 444413304
VISIT DATE: 06/21/2023
NARRATIVE
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Indoor areas of the facility were inspected and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, and play equipment. The floors were clean and free of tripping hazards. During today's inspection, LPA observed children playing with small activities such as blocks, baby dolls, and musical instruments. Drinking water is readily available for children via water dispensers and water bottles from home labeled with the children’s names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child can use if necessary. There is a working telephone in the facility.

The outdoor area of the facility was inspected and observed to be fenced in. The playground located outside needs repair as the surface was observed to be peeling and exposing rust beneath along most of the playground. LPA advised resurfacing the playground to cover visible rusting and remove plastic that is peeling away as it is hardened and poses a hazard to children playing on the play structure. LPA additionally advised adding tanbark to raise the level of the ground beneath the structure. There is approximately 1 1/2 feet between the base of the side and tanbark beneath as well as from the first step onto the playground and the tanbark. The playground currently has a foam mat under the slide, however it is portable by design and not permanently fixed to the ground. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and building overhang.

The facility offers AM/PM snack and children enrolled provide their own lunches. The snack menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA advised adding portion sizes to the snack menu. The kitchen and storage area is clean and free of litter and rubbish.

Five children’s files were reviewed and all required documents were present. The Site Supervisor and Teacher (Fatima) files were reviewed and all required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 2/23/2025. The Site Supervisor has current Mandated Reporter Training that expires on 4/6/2024. LPA reminded that the Mandated Reporter Training must be renewed by all staff every 2 years.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER
FACILITY NUMBER: 444413304
VISIT DATE: 06/21/2023
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The Site Supervisor shall be on the premises during the hours the center is in operation and children at the center shall be visually supervised at all times. LPA advised 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, such as field trips.

Exit interview conducted and report was reviewed with the Site Supervisor, Jamie Delaney and Administrator, Lisa Hindman Holbert.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 02:52 PM - It Cannot Be Edited


Created By: Cortney Nelson On 06/21/2023 at 11:59 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: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER
FACILITY NUMBER: 444413304

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the Department was not notified of changes in Site Supervisor, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Qualifications were submitted for Jamie to LPA Nelson on 4/24/2023. Deficiency cleared.
Type B
Section Cited
HSC
1596.841
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the facility roster has not been updated since 6/2021, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Cleared during visit.
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:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 02:52 PM - It Cannot Be Edited


Created By: Cortney Nelson On 06/21/2023 at 12:30 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: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER
FACILITY NUMBER: 444413304

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
(a) the child care center shall be clean, safe, sanitary, and in good repair at all times to ensure the safety and well-being of children, employees, and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as the playground was observed to need repair work, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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The Licensee will submit a plan of action to the Department by 6/30/2023 for repair of the playground structure and address the following issues: tanbark levels are too low from the base of the slide and the base of the stairs to access the structure, plastic peeling from the playground surface is causing exposed metal, which is rusting, creating a hazard for children. Surface of the playground and especially staircase need to be repaired.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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