Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703722
Report Date: 09/16/2016
Date Signed 09/16/2016 12:33:38 PM

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:JAMES LICK CHILDREN'S CENTERFACILITY NUMBER:
430703722
ADMINISTRATOR:DEBORAH BARNESFACILITY TYPE:
850
ADDRESS:57 NORTH WHITE ROADTELEPHONE:
(408) 928-5241
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:19CENSUS: DATE:
09/16/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Carmen GenizTIME COMPLETED:
12:35 PM
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LPA Meela Aguas met with Site Director, Carmen Geniz for an unannounced annual/random visit. Analyst toured the facility building and grounds. Clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing Division. LPA reminded Carmen of the zero tolerance related regulations, the healthy beverages in Child Care and the new CA car seat law.
Facility Review:
No bodies of water. Director states there are no weapons at the center. Medications are kept high in the gated kitchen cabinet inaccessible to children. Furniture and equipment is age appropriate and in good condition free of sharp, loose or pointed parts. Children's bathroom appears in safe and sanitary operating condition. Floors appear clean and safe. Trash cans for solid waste have tight-fitting covers and in good repair. Disinfectants, cleaning solutions, poisons and other dangerous items were inaccessible to children. Storage areas for poisons were locked.
Menus posted and appropriate. Clean drinking water is available indoors and out. Kitchen, food preparation and storage areas are clean. No flies, insects or rodents were observed during the visit.
Playground has poured rubber foam for cushioning material under the climbing structures and surrounding area. Playground equipment is in good condition. Children were supervised during the visit. There was a ratio of one teacher supervising no more than 8 children in attendance. There were also student trainees from James Lick High School who goes to the center for an hour as part of their lab class. Person who signed in/out the child used full legal signature and time was recorded. Children's files have admission agreement available for review. There's no change of staff since the last annual visit. Observed CPR & First Aid training certification expires in 10/2017 for all 3 staff person. Licensee operates within the conditions, limitations and capacity specified on the license. Incidental Medical Services were discussed with the licensee. This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment /supplies, and reviewed child's, personnel and administrative records.
Facility is in compliance with CA Code of Regulations, Title 22. No deficiency cited.

NOTICE OF SITE VISIT WAS ISSUED AND POSTED.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Milagros AguasTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2016
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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