430700549-12-7-2022-07-CC-AMOS-CLVV2Y-20221207150356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700549
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:04:10 PM

Document Has Been Signed on 12/07/2022 03:04 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SAN JOSE DAY NURSERY		FACILITY NUMBER:	430700549
ADMINISTRATOR:	ELENA JOLLY		FACILITY TYPE:	850
ADDRESS:	33 NORTH 8TH STREET		TELEPHONE:	(408) 288-9667
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY: 88	TOTAL ENROLLED CHILDREN: 88	CENSUS: 36	DATE:	12/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Angela Gomez		TIME COMPLETED:	02:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Anna Morales met with the Executive Director Angela Gomez for an unannounced annual inspection. LPA toured the facility both inside and outside during today’s visit. LPA observed the required posted materials including: The Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents’ Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedules. Last disaster drill was conducted on 10/20/22. The Preschool Program is operating in Rooms 1-6. Facility was observed to be in compliance with teacher to infant ratio requirement. Room 1- PRE K: Nine children and one teacher and one teacher's assistant Room 2- Not Occupied Room 3: Eight Children and two teachers Room 4: Six children and, two teachers Room 5: Eight Children and two teachers Room 6: PRE -K: Eight children and one teacher and one teacher assistant LPA toured the facility both indoor and outdoor. Fire extinguisher, smoke and carbon monoxide detectors were observed. There were no bodies of water observed. Children have access to water when indoor and outside. Director stated that the facility does not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. Outdoor activity spaces are enclosed by fencing and are observed to be free of hazards. LPA observed play equipment were in good condition.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAN JOSE DAY NURSERY	FACILITY NUMBER: 430700549
	VISIT DATE: 12/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility provides breakfast, lunch and two snacks (morning and afternoon). LPA observed that food storage areas were clean and free of litter. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on, and were in good repair.

This facility is providing Incidental Medical Services – LPA observed that the medications are stored in central location and its inaccessible to the children. LPA reviewed a random selection of medications and supporting documentation. Director stated there is an isolation area for sick children to wait for parent pick-up.

LPA reviewed sign in and out record, and obtained a copy of a current children's roster. LPA reviewed a random selection of children files. Children records reviewed include Identification and Emergency Contact (LIC700), Personal rights(LIC614), Admission Agreement, Medical Assessment, Immunization, Notification of Parents Rights (LIC995),and Consent for Emergency Medical Treatment(LIC627).

LPA reviewed a random selection of Staff records which included Immunization (Measles, Pertussis, and Flu) record, Health Screening(LIC503), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and required Training. LPAs reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAN JOSE DAY NURSERY	FACILITY NUMBER: 430700549
	VISIT DATE: 12/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA discussed the requirements of AB 633 with the Director. The Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

No Deficiencies are being cited based on the LPA's observations, interviews conducted and records reviewed in accordance with the California Code of Regulations Title 22.

LPA was unable to leave a copy of this report due to technical difficulties.

NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE CENTER FOR A PERIOD OF 30

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3