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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400382
Report Date: 06/11/2024
Date Signed: 06/14/2024 08:47:32 AM

Document Has Been Signed on 06/14/2024 08:47 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:YWCA DAVIDSONFACILITY NUMBER:
434400382
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, JEANINEFACILITY TYPE:
830
ADDRESS:350 SOUTH THIRD STREETTELEPHONE:
(408) 295-4011
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
06/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Betty Robles/Lucille GabrielTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Anna Morales conducted an Annual Random Inspection. LPA was greeted by Site Director Betty Robles and Program Director Lucille Gabriel. Days and hours of operation is Monday- Friday 7:00am-6:00pm: ages from 6 wks to 2 years old. Facility's License, Notification of Parents’ Rights Poster, Child Care Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. Last disaster drill was conducted on May 17, 2024. Facility has a waiver for shared usage of outdoor space with the toddlers.

The facility operates on two separate floors. At this present time, the classroom upstairs and playground is not operating. The Toddler Option/Preschool program (430710536) are, also, on the first floor.

LPA observed two staff to five infants. The facility was operating in compliance with children to teacher ratio requirement.

Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. LPA observed a diaper changing table within arm's reach of a sink. Site Director stated that the facility has a third party cleaning service that comes after day care hours to clean the facility.

LPA observed that the Infant 15-minute sleep check are being conducted and diapering times are being documented. Director states if a child comes to the facility who exhibit symptoms of illness including, but not limited to, fever or vomiting, they are not accepted into care. Any children who become ill during the day, shall be isolated in the area close to the door in the classroom while they wait for a parent/guardian to come and pick them up.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: YWCA DAVIDSON
FACILITY NUMBER: 434400382
VISIT DATE: 06/11/2024
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The center provides breakfast, lunch, and afternoon snacks to the children. There is a kitchen at the facility. Foods and beverages were kept protected against contamination and spoilage. The kitchen is equipped with refrigerator, stove, oven, microwaves, storage space for food, and a sink with warm/hot and cold running water. Drinking water is available for the children indoor via sippy cups and individual water bottles. LPA observed trash cans with tight fitting covers for the disposable of solid wastes and diapers. The facility has fire extinguishers and working smoke and carbon monoxide detectors.

LPA reviewed three (3) random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Immunizations, Parent Right's Receipt, Personal Rights, Infant Needs and Services Plan, and Individual Infant Sleeping Plan (LIC 9227) for children 0-12 months.

LPA reviewed three (3) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPA reminded Site Director that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility provides Incidental Medical Services – IMS. Director stated that there are no children who are taking any medications at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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: YWCA DAVIDSON
FACILITY NUMBER: 434400382
VISIT DATE: 06/11/2024
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Site Director, Betty Robles 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.

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 child care center licenses issued after July 1, 2022, the licensee 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 Director, Betty Robles, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, there were no deficiencies cited. Exit interview conducted and report was reviewed with Site Director, Betty Robles.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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