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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416436
Report Date: 05/02/2024
Date Signed: 05/02/2024 06:08:00 PM

Document Has Been Signed on 05/02/2024 06:08 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:L'ACADEMY PRESCHOOL SANTA CRUZFACILITY NUMBER:
444416436
ADMINISTRATOR/
DIRECTOR:		LANIE CHOIFACILITY TYPE:
830
ADDRESS:3205 SALISBURY DRIVETELEPHONE:
(415) 361-1879
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY: 13TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Lanie ChoiTIME VISIT/
INSPECTION COMPLETED:
04:41 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with the Site Director, Lanie Choi, for an unannounced Annual/Random Inspection. LPA was granted access to the facility by staff members present and toured both indoors and outdoors during the inspection. Upon arrival, there were four infants and two staff members present, 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, 7:30AM-5:30PM.

LPA reviewed sign-in/out, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed digitally using 1Core. The last fire/disaster drill was conducted on 4/26/2024, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 8/2023), built in fire detector system and functioning carbon monoxide detector. There are children in care who require Incidental Medical Services for EpiPens and administers medication at this time. LPA observed that medication is properly stored out of reach of children with the proper documentation. One EpiPen was observed to be expired during today's visit and LPA advised obtaining a new one from the child's authorized representatives. There are no weapons or firearms on the premises.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. 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: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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 05/02/2024 06:08 PM - It Cannot Be Edited


Created By: Cortney Nelson On 05/02/2024 at 02:42 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: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above for one out of two infant staff members present, who requires an exemption transfer, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
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POC corrected during todays inspection, the Site Director submit required paperwork to request exemption transfer for one staff member.
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 interview and record review, the licensee did not comply with the section cited above as both staff are missing proof of immunization to measles and one for immunization to pertussis, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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The Site Director shall submit proof of immunization for two staff members for measles/pertussis or blood panel testing for immunity by 5/31/2024. LPA reminded immunizations for staff shall be obtained within 30 days of hire.
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: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/02/2024 06:08 PM - It Cannot Be Edited


Created By: Cortney Nelson On 05/02/2024 at 02:42 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: 05/02/2024

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 interview and record review, the licensee did not comply with the section cited above as one out of two staff members present did not complete a health screening or TB test, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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The staff member shall schedule a health screening appointment and conduct a TB test. Results to be submitted to the Department by 5/31/2024. LPA reminded that health screening and TB test shall be completed within 7 days of hire.
Type B
Section Cited
CCR
101226(e)(5)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (5) The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

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 one infant's EpiPen was observed to be expired in 3/2024, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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The Site Director to check in with parents and return expired EpiPen. New EpiPen shall be provided to the center and proof shall be submitted to the Department by 5/17/2024.
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: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/02/2024 06:08 PM - It Cannot Be Edited


Created By: Cortney Nelson On 05/02/2024 at 02:42 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: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

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 all five infant files reviewed needed to update Needs and Services plan or obtain a Needs and Services plan, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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The Site Director shall update Needs and Services plan or obtain Needs and Services plan for infants in care and submit proof of completion to the Department by 5/17/2024.
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: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


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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: 05/02/2024
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. The infant room is physically separate from areas for the preschool component. LPA observed sufficient age-appropriate materials, toys, and play equipment for infants. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. The infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. The infant program starts at 12 months of age and LPA observed napping mats are used for the mobile infants. The floors are clean and free of tripping hazards and waste containers have tight fitting lids. Licensee understands that all formula and bottles provided should be labeled individually with the child’s name and the date.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The outdoor area of the facility was inspected and observed to be fenced in and physically separated from space utilized by preschool children. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (turf) to absorb falls. There are plastic play structures, riding bikes/cars, and other small toys for infants to play with outdoors. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by building overhang and Lanie states that there are additional canopies that are used when the weather gets hotter.

Five (5) infant files were reviewed and most required documents were present. LPA reminded that the Needs and Services plan shall be updated at least quarterly and observed that infant nap check documentation was present.

Three staff files were reviewed and most required documents were present. LPA reminded that new staff shall complete physicians report/TB test within seven days of hire. Lanie has current CPR/First-Aid that expires 6/2025 and her Mandated Reporter Training expired on 4/26/2023. 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: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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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: 05/02/2024
NARRATIVE
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Licensee 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.

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 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 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: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
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