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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703019
Report Date: 09/23/2022
Date Signed: 09/23/2022 10:52:08 AM

Document Has Been Signed on 09/23/2022 10:52 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ACTION DAY NURSERIES & PRIMARY PLUS INC.FACILITY NUMBER:
430703019
ADMINISTRATOR:JESSICA GUZMANFACILITY TYPE:
850
ADDRESS:333 EUNICE AVENUETELEPHONE:
(650) 967-3780
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 107TOTAL ENROLLED CHILDREN: 107CENSUS: 64DATE:
09/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director Jessica GuzmanTIME COMPLETED:
10:50 AM
NARRATIVE
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On Friday 9/23/2022 at approximately 9:30 am Licensing Program Analyst Sabina Dodoo met with Director Jessica Guzman for an Unannounced Case Management Visit for Lead Testing Result at Action Day Nurseries & Primary Plus Inc.Present for the inspection were Director and 11 staff. The census was 64 children. The facility operates Monday through Friday 7am to 6pm.

LPA and Director toured the facility and LPA obtained photos of the faucets in the classrooms. A Plan of correction was discussed with the Director. This facility is being given a Type B citation for California Code of Regulations ,Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds.(Please see 809D page for citation and Plan Of Correction details).

Exit interview was conducted with Director Jessica Guzman. A copy of this report was provided. A notice of site visit was given and appeal rights. This report shall remain on file for 3 years.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 09/23/2022 10:52 AM - It Cannot Be Edited


Created By: Sabina Dodoo On 09/23/2022 at 10:37 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ACTION DAY NURSERIES & PRIMARY PLUS INC.
FACILITY NUMBER: 430703019

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2022
Section Cited
CCR
101238(a)

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101238(a)Buildings and Grounds
The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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LPA observed the facility has shut down the faucet completely and it is covered. The children are using personal water bottles that are refilled through a Brita water filter.
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This requirement was not met as evidenced by: Based on observation and documentation of the Lead Testing Result, the facility has one faucet that exceeds the 5PPB level.
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Director must submit proof of to LPA via email, that the water outlet will be taken off the premises or will be repaired and replaced. The documentation must be submitted to LPA no later than 10/24/2022.
Email: [email protected]

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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:Chandra Charles
LICENSING EVALUATOR NAME:Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022


LIC809 (FAS) - (06/04)
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