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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416436
Report Date: 07/25/2022
Date Signed: 07/27/2022 10:24:25 AM

Document Has Been Signed on 07/27/2022 10:24 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:L'ACADEMY PRESCHOOL SANTA CRUZFACILITY NUMBER:
444416436
ADMINISTRATOR:NOLAN, KARENFACILITY TYPE:
830
ADDRESS:3205 SALISBURY DRIVETELEPHONE:
(415) 361-1879
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY: 13TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lanie ChoiTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Lanie Choi, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by Staff Member, Andrea Rocha, and toured both indoors and outdoors during the inspection. Upon arrival, there were 7 infants and 2 staff (1 teacher/1 assistant) present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday, 7:30AM-5:30PM.

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. The last fire/disaster drill was conducted on 4/4/2022, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 1/2021), functioning smoke detector and carbon monoxide detector. LPA advised Site Director of recommended annual service for fire extinguishers. Site Director states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Site Director states that 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: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436
VISIT DATE: 07/25/2022
NARRATIVE
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Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for day care infants. Infant room at the facility is physically separate from the preschool component. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. Infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. The floors are clean and free of tripping hazards and waste containers have tight fitting lids. LPA observed infant bottles in the fridge that need proper labeling of child's name and date. All infants have a current Needs and Services plan that has been updated quarterly.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Site Director, including the documented nap checks. Infants should be supervised while sleeping and nap check documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant.

The outdoor area of the facility was inspected and observed to be fenced in and physically separated from space utilized by the preschool component. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (rubber padding) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy.

9 infant files were reviewed during today’s inspection and most required documents were present. 3 staff files (site director, 1 teacher, 1 assistant) were reviewed and most required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 8/2022. The Site Director has current Mandated Reporter Training that expires on 4/26/2023. LPA reminded Site Director that the Mandated Reporter Training must be renewed by all staff every 2 years.

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

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
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Document Has Been Signed on 07/27/2022 10:24 AM - It Cannot Be Edited


Created By: Cortney Nelson On 07/25/2022 at 04:14 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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

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 observation, interview, and record review, the licensee did not comply with the section cited above for one staff member out of two, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2022
Plan of Correction
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Site Director will submit proof of MMR vaccine for staff member, Corina Hernandez, by 8/5/2022.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one out of two staff members, whose mandated reporter certificate expired 5/2022, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will submit proof of completed Mandated Reporter training certificate for staff, Corina Hernandez, by 7/29/2022.
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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


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Page: 3 of 8
Document Has Been Signed on 07/27/2022 10:24 AM - It Cannot Be Edited


Created By: Cortney Nelson On 07/25/2022 at 04:14 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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one out of two staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2022
Plan of Correction
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Site Director will submit proof of negative tuberculosis (TB) test for staff, Natalie Gutierrez by 8/5/2022.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one child in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2022
Plan of Correction
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Site Director will submit physicians report for child (C1) by 8/5/2022.
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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


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Document Has Been Signed on 07/27/2022 10:24 AM - It Cannot Be Edited


Created By: Cortney Nelson On 07/25/2022 at 04:14 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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above and did not have immunization record for one out of nine infants in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will obtain immunization record for one infant (C1) who does not have immunization record and submit to Licensing by 7/29/2022. Immunization record should be maintained in childs file.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

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 for new digital sign-in/out process that does not require full legal signature of parent/guardian, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will reach out to application "1Core" and add the function for parents to sign-in/out using full legal signature. Until application is able to intake full legal signature of parents, Site Director will use paper sign-in/out along side digital sign-in until app is compatable with the regulation requirements.
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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


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Document Has Been Signed on 07/27/2022 10:24 AM - It Cannot Be Edited


Created By: Cortney Nelson On 07/25/2022 at 04:14 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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

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 observation, interview, and record review, the licensee did not comply with the section cited above for new Site Director, Lanie Choi, who started employment 7/1/2022 without reporting to Licensing, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will submit qualifications to be reviewed and Owner, Helena Geng, will submit all required supplemental documentation for designation of new site director by 7/29/2022.
Type B
Section Cited
CCR
101427(j)
Infant Care Food Service
(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

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 for bottles stored in the fridge without proper name and date label, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will remind all staff of requirement for bottles to have name of infant and date received. All bottles in fridge will be properly labeled and Site Director will submit photo for each day of the week with bottles received for infant program.
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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


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Page: 6 of 8
Document Has Been Signed on 07/27/2022 10:24 AM - It Cannot Be Edited


Created By: Cortney Nelson On 07/25/2022 at 04:25 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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
101170 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one out of three staff present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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Site Director will transfer fingerprint association for herself to the facility by 7/26/2022.
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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


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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: L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER: 444416436
VISIT DATE: 07/25/2022
NARRATIVE
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The Site Director understands that she shall be on the premises during the hours the center is in operation and that infants at the center shall be visually supervised at all times. LPA reminded Site Director 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 Director, Lanie Choi.

As a result of today’s inspection, deficiencies were cited, see 809-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: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
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