Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710447
Report Date: 01/24/2018
Date Signed 04/05/2018 11:55:32 AM

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: 12DATE:
01/24/2018
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Debra ChristieTIME COMPLETED:
02:50 PM
NARRATIVE
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THIS IS AN AMENDED REPORT.

Unannounced case management inspection made by LPA's Pam Burkett and Tuoc Doan. Met with Assistant Director Debra Christie. There were 12 infants present with 3 fully qualified teachers.

Two infant's were asleep in swings. One of the infants in the swing was swaddled. There was an infant in the crib room and there was not a staff person providing direct visual observation and supervision to the napping infant.

The following type B deficiencies are being cited.

Appeal rights were provided and exit interview was conducted.

Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Pam BurkettTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CARING HEARTS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430710447
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/31/2018
Section Cited
CCR
101429(a)(1)
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Responsibility for Providing Care and Supervision for Infants -Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. One infant was asleep in the crib area. There was no staff in the crib area. Staff was also caring for one infant in her arms and two other awake infants. Staff was not providing direct visual observation and supervision of sleeping infants.
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Corrected during inspection. A staff person moved in the room with 3 additional children. Written plan of correction will be submitted by 1/31/18

Originally there was a staff person on the other side of the window directly across from the child.
Request Denied
Type B
01/31/2018
Section Cited
CCR
101223(a)(7)
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Personal Rights. Children shall be provided safe and healthful accommodations. C1 and C2 were asleep strapped in swings. C1 was also swaddled.
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Corrected during visit - the infant's swaddle was removed and both infants were moved from the swings to the crib area for sleeping.

Licensee shall submit statement regarding safe sleep practices by 04/13/18.

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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: Anthony StudebakerTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2018
LIC809 (FAS) - (06/04)
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