Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710447
Report Date: 11/06/2017
Date Signed 11/06/2017 02:37:24 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:CARING HEARTS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430710447
ADMINISTRATOR:DELORIS J. ARORAFACILITY TYPE:
830
ADDRESS:645 WEST FREMONT AVENUETELEPHONE:
(408) 245-6356
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:12CENSUS: 9DATE:
11/06/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Deloris AroraTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Mel Matos, met with Deloris Arora, owner/director, for an unannounced case management inspection in response to an Unusual Injury that the Facility self reported to Community Care Licensing (CCL) via telephone and written report.

The Unusual Incident occurred on October 24, 2017 when an infant aide felt a squishy, soft bubble on the left side of a 10 month old infant child's head. This occurred after lunch, around 12 noon, when the aide was holding the child head as she was cleaning the child's face. Deloris states that the soft bubble was hidden by the child's hair and was not visible by just looking at the child. Deloris states that the aide asked another infant teacher and the assistant director to look at the soft bubble on the child's head. Deloris states that the staff proceeded to contact the child's father to come pick up the child since they felt that the child should be taken to the doctor for observation. Deloris states that staff did not notice anything abnormal with the child prior to 12 noon on October 24, 2017. Deloris states that the child did not exhibit any signs of having a head injury prior to the discovery of the squishy, soft bubble on the left side of the child's head.

Deloris states that the child's father came within 20 minutes to pick up the child and staff advised him to take the child to see a doctor. Deloris states that staff wrote an ouch report for the child's father, but notes that the father did not take it from the Facility. A copy of the ouch report was provided to LPA. Deloris states that the child's father notified her on October 27, 2017 that the child was diagnosed with a skull fracture. Deloris states that the child's father also indicated to her that the child would be staying at home for several weeks and that the child would not be returning to the Facility. Deloris states that the child's father has not come by the Facility to pick up the child's belongings nor provided her with any doctor's note regarding the child's diagnosis.

Deloris states that she normally has 10-12 infants in the infant room with 3 staff (2 teachers and 1 aide) and states that the infant children are supervised at all times. Deloris states that she also has two floater staff that help cover breaks and lunches for the infant staff.

Deloris states that she submitted a suspected child abuse report to the Santa Clara County Department of Family and Children Services on October 28, 2017 because she suspects that the child sustained the injury in the child's home. Deloris states that she received a letter from the Santa Clara County Department of Family and Children Services last week indicating that the matter "does not meet the State requirements for intervention." A copy of the letter was provided to LPA.

No deficiencies issued during today's inspection. LPA will follow up with Deloris if any additional information is required.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2017
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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