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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415586
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:32:32 PM

Document Has Been Signed on 03/13/2024 02:32 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:KING CITY EARLY EDUCATION & CHILD CARE CENTERFACILITY NUMBER:
274415586
ADMINISTRATOR:FANNY CHAVEZFACILITY TYPE:
850
ADDRESS:525 N. RUSS STREET, ROOMS 6&7TELEPHONE:
(831) 202-1230
CITY:KING CITYSTATE: CAZIP CODE:
93930
CAPACITY: 40TOTAL ENROLLED CHILDREN: 30CENSUS: 26DATE:
03/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Maria RodriguezTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Martha Jimenez-Villanueva conducted a Case Management Inspection. LPAs met with Maria Rodriguez, Site Director and explained the nature of today's visit to her.
On February 12, 2024, the licensee self-reported an unusual incident, a child (ch 1) was left behind without supervision in the playground area. Regulation 101229(a)(1) - Responsibility for Providing Care and Supervision is listed on continuation page Lic809D.
Upon arrival LPAs observed 26 children and five staff members were supervising them.


Type A deficiency cited on the following page (Lic899D)
Exit interview conducted and copy of this report provided to the facility.

LPA discussed the requirements of AB633 to the Site Director. LPA provided licensee the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) both in English and in Spanish and licensee stated she understands the requirements. Upon receipt, the licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee rights were provided to the Site Director.

Failure to comply with the Plan of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day for each deficiency.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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
Document Has Been Signed on 03/13/2024 02:32 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 03/13/2024 at 01:26 PM
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: KING CITY EARLY EDUCATION & CHILD CARE CENTER
FACILITY NUMBER: 274415586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/14/2024
Section Cited
CCR
101229(a)(1)

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(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Licensee has provided training on supervision to the staff and has provided licensing program with a attendance list. Licensee was instructed on the requirements of the AB633.
LPA discussed the requirements of AB633 to the Site Director. LPA provided licensee the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224)
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This regulation was not met as evidenced by: Licensee self reported an incident were a child was left without supervision for a period of four minutes. This poses an immediate risk to the child (ch 1) in care.
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 both in English and in Spanish and licensee stated she understands the requirements. Upon receipt, the licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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:Susy Cervantes
LICENSING EVALUATOR NAME:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024


LIC809 (FAS) - (06/04)
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