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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709457
Report Date: 09/20/2021
Date Signed: 09/20/2021 03:53:27 PM

Document Has Been Signed on 09/20/2021 03:53 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GOOD SAMARITAN EDUCATION & ENRICHMENT PROGRAMSFACILITY NUMBER:
430709457
ADMINISTRATOR:CORIA, GUADALUPEFACILITY TYPE:
850
ADDRESS:19624 HOMESTEAD ROADTELEPHONE:
(408) 996-8290
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 71TOTAL ENROLLED CHILDREN: 0CENSUS: 27DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Guadalupe Coria & Stacey O'tooleTIME COMPLETED:
12:00 PM
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#2 Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year inspection. LPA met with Site Director, Guadalupe Coria, and Assistant Director, Stacey O'Toole, and explained the purpose of today's inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center is open Monday through Friday from 07:00 AM to 6:00 PM. Age serve is 2 years to entry into first grade. The preschool program is licensed in Rooms 11, 12, Multipurpose Room, 24, 25, and 26.

LPA toured the indoor and outdoor areas. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. There were no bodies of water observed. Per Site Director, there were no 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. Restrooms for children to use were observed to be in operating conditions.

Outdoor activity spaces are enclosed by fencing and are observed to be free of hazards. LPA observed play equipment were in good condition and areas around the climbing structures have resilient material. Drinking water was readily available to children indoor and outdoor via water bottles. Activities schedule and Menus were posted. Facility provides morning and afternoon snacks and are prepared in the kitchen located on-site. LPA observed that food storage areas were clean.

Continuation on next page:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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: GOOD SAMARITAN EDUCATION & ENRICHMENT PROGRAMS
FACILITY NUMBER: 430709457
VISIT DATE: 09/20/2021
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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. LPA observed working smoke detector and functioning carbon monoxide detector.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

LPA reviewed sign in and out. Ten children's files and eight staff's files were reviewed. LPA reminded Site 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 Site 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.

An updated Personnel Report (LIC 500) to be sent to Licensing by September 27, 2021.

Site Director submitted an updated Administrative Organization (LIC 309) today.

As a result of this inspection, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC809 (FAS) - (06/04)
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