Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414640
Report Date: 02/14/2018
Date Signed 02/14/2018 10:03:30 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:CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESAFACILITY NUMBER:
434414640
ADMINISTRATOR:CLAUDIA HERNANDEZFACILITY TYPE:
830
ADDRESS:196 MARTINVALE LANETELEPHONE:
(408) 644-7614
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY:8CENSUS: 6DATE:
02/14/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Claudia HernandezTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tony Studebaker conducted an unannounced, Annual/Random, inspection on today's date. LPA met with the Director and explained the nature of today's inspection. LPA noted 6 infants and 2 infant teachers. LPA noted the staff and infants were interacting in various activities. The facility was in compliance with teacher/infant ratios, children were not left unattended and were constantly under the direct visual supervision of a staff person.

LPA completed a physical plant inspection touring the building inside and out. No bodies of water were found. Director denies any weapons stored in the facility. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to infants were inaccessible. Furniture and equipment was in good condition, free of sharp, loose, or pointed parts. Facility has age appropriate furniture and equipment, including cribs, mats, feeding chairs, and changing tables. Infant changing table is located within arms reach of a sink. No baby walkers or bouncers were witnessed during the inspection. All storage containers for solid waste had tight fitting covers and were in good repair. Facility was free of flies, other insects, and rodents. Facility has adequate indoor activity space for infants that is physically separate from space used by the preschool child care center. Bottles, dishes, and containers of food brought by the infant's authorized representative are labeled with the infant's name but did not have the date. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Facility has adequate outdoor activity space and play equipment that is maintained in a safe condition and is free of hazards. Temperature was comfortable in the classroom. At the time of inspection the child care center was clean, safe, sanitary, and in good repair for the well-being of children, employees, and visitors.

(Report continued on Page 2 - 809-C)
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
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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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: CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESA
FACILITY NUMBER: 434414640
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2018
Section Cited
CCR
101427(j)
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INFANT CARE FOOD SERVICE - 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.

Bottles and food were labeled with the name
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Director and staff shall label all bottles and food with the current date and Director shall complete training with all infant staff to review infant care food service regulation including labeling. A copy of the training agenda and sign in sheet shall be provided to Community Care Licensing (CCL) by the POC date.
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but were missing the current date.
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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: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
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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: CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESA
FACILITY NUMBER: 434414640
VISIT DATE: 02/14/2018
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(Report continued from Page 1 - 809)

LPA completed a review of facility documentation and found that the facility is operating within the approved capacity of the fire clearance. The person who brings the infant to, and removes the infant from the center, signs the infant in and out. LPA obtained a copy of the facility roster. A review of staff records indicates that all staff subject to a criminal record review have obtained a clearance or criminal record exemption and have completed a medical assessment including a TB test. Personnel records are maintained on the Director and each employee. Facility records also indicate that all teachers have the appropriate education credits and there is at least one person present trained in Pediatric CPR and First Aid when infants are at the facility. Facility records did show the proper documentation for the Measles, Pertussis, and Influenza vaccinations. A review of infants records were completed and the records did contain an admission agreement. All infants have a needs and services plan, and an individual feeding plan. LPA reviewed safe sleep policies for the infants with the Director and provided "A Child Care Provider's Guide to Safe Sleep." LPA also discussed the updates to the seat belt law and provided a copy of the new poster. LPA advised the Director to check Community Care Licensing's website for continuous updates.

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 Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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


(Report continued on Page 3 - 809-C)
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESA
FACILITY NUMBER: 434414640
VISIT DATE: 02/14/2018
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(Report continued from Page 2 - 809-C)

LPA and the Director discussed the recent passage of Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. LPA confirmed with the Director that once staff complete the training they shall print their certificates and place them in their personnel files.

Licensing forms, title 22 regulations, mandated child abuse training, and information can be obtained through the internet at www.cdss.ca.gov.

Deficiency was issued during the inspection. Deficiency, Plan of Correction (POC), and Appeal Rights discussed with the Director. Appeal Rights provided to the Director. Exit interview conducted with the Director.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
LIC809 (FAS) - (06/04)
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