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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270704157
Report Date: 10/16/2025
Date Signed: 10/16/2025 12:32:52 PM

Document Has Been Signed on 10/16/2025 12:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SERENDIPITY PRE-SCHOOLFACILITY NUMBER:
270704157
ADMINISTRATOR/
DIRECTOR:		CAMPBELL, FRANCESCAFACILITY TYPE:
850
ADDRESS:1231 SEVENTH STREETTELEPHONE:
(831) 375-9743
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 23DATE:
10/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:CArisa AbliaTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On October 16, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced annual Inspection. The purpose was explained to Director Carisa Ablia who granted access and received the Entrance Checklist (LIC 125).

Director, 6 Teachers and 23 children were present on site. The school operates Monday through Friday from 8:00 a.m. to 5:30 p.m. All students receive a morning snack provided by the school. Full-time students receive an additional afternoon snack. Parents are responsible for sending lunches and water bottles. The school supplies extra food if needed and provides water throughout the day. Snacks are prepared in the school kitchen, which is equipped with a refrigerator-freezer, stove, oven, microwave, and access to hot and cold water.

LPA reviewed sign-in and sign-out records. Required postings were visibly displayed. The most recent fire drill occurred on 8/25/25. A fully charged 3A-40-BC fire extinguishers was observed, last serviced on 3/3/25. An operating telephone was present on site. The Director confirmed no firearms are on the property.

LPA verified that all staff members have fingerprint clearance. Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/16/2025 12:32 PM - It Cannot Be Edited


Created By: Darnella Barnes On 10/16/2025 at 11:30 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SERENDIPITY PRE-SCHOOL
FACILITY NUMBER: 270704157

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Two Staff members (S3 and S5) are missing pertussis and measles immunizations
POC Due Date: 11/06/2025
Plan of Correction
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The director will provide documentation of missing immunizations for two staff members by the due date. The director will also submit a plan of correction outlining how this issue will be prevented in the future
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Staff member S3 is missing TB.
POC Due Date: 11/06/2025
Plan of Correction
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The director will provide documentation of missing TB of staff by the due date. The director will also submit a plan of correction outlining how this issue will be prevented in the future
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Darnella Barnes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2025


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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SERENDIPITY PRE-SCHOOL
FACILITY NUMBER: 270704157
VISIT DATE: 10/16/2025
NARRATIVE
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Inside the facility, the environment was clean, safe, and well-maintained. The flooring was in good condition and free of tripping or slipping hazards. Toy containers feature smooth edges, appropriate ventilation, and lids designed to prevent finger entrapment. Children were safeguarded from slipping risks, and each child had a space for storing personal belongings. The bathroom facilities meet the requirement of having at least one sink and toilet for every 15 children. Toileting areas including sinks, dispensers, walls, and floors were regularly cleaned and disinfected.

Cleaning products and chemicals were stored securely in locked cabinets, away from food and out of children’s reach. Floors were mopped and carpets vacuumed daily using water and disinfectants, which were safely disposed of. Trash was discarded in covered containers. Indoor temperature read 72°F.

LPA Barnes reviewed 5 children's files. All files were complete and included the Admission Agreement, Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Physician's Report (LIC 701), immunization records, Personal Rights (LIC 613A), Notification of Parent’s Rights (LIC 995A), and Child's Pre-admission Health History. LPA reviewed the facility roster and sign-in/out records. Instead of signatures, each adult uses a unique PIN to sign in and out. The system verifies and records times linked to each individual’s assigned PIN.

LPA Barnes reviewed six staff files. Each file included current Pediatric First Aid/CPR and Mandated Reporter Training certificates, a job application, health screening, child abuse reporting acknowledgment, employee rights form, and proof of meeting education requirements. Most files also showed TB clearance and immunization records for pertussis, measles, and influenza or a signed declination for the flu shot. However, two staff members were missing records for pertussis, measles, and TB clearance. As a result, a Citation B was issued, as noted on the attached LIC809D.

LPA reminded the Director that Mandated Reporter Training must be renewed every two years and that at least one staff member must have current CPR/First Aid certification at all times. LPA also advised that aides and assistants must be under the direct supervision of a qualified teacher, except during nap time and when taking children to the bathroom

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SERENDIPITY PRE-SCHOOL
FACILITY NUMBER: 270704157
VISIT DATE: 10/16/2025
NARRATIVE
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First-aid supplies were accessible to staff but out of reach of children. The kit included a first aid manual, bandages, scissors, adhesive tape, thermometer, tweezer and antiseptic solution.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

During the outdoor inspection, LPA observed that all walkways, ramps, and stairs were clear of tripping hazards. The play area had proper shade, was well-organized to prevent accidents, and the ground was free of debris or dangerous items. The outdoor area was fully enclosed by a fence at least five feet high. No dangerous equipment, chemicals, or utility fixtures were accessible. No outdoor bodies of water were found.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the Site Supervisor shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.



Site Supervisor was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California..

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SERENDIPITY PRE-SCHOOL
FACILITY NUMBER: 270704157
VISIT DATE: 10/16/2025
NARRATIVE
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During today’s inspection, two “Type B” deficiencies are issued on attached 809-D. Appeal rights provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Carisa Ablia




-----END OF REPORT -----
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6