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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408823
Report Date: 10/04/2022
Date Signed: 10/04/2022 08:08:19 PM

Document Has Been Signed on 10/04/2022 08:08 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:GLORIA DEI EARLY LEARNING CENTERFACILITY NUMBER:
434408823
ADMINISTRATOR:ROSE MARIE DUFFYFACILITY TYPE:
850
ADDRESS:121 SOUTH WHITE ROADTELEPHONE:
4082720321
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 11DATE:
10/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Maria Nugent TIME COMPLETED:
03:23 PM
NARRATIVE
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Licensing Program Analysts (LPA), Stephanie Collins, conducted an unannounced Annual inspection of the Preschool. LPA met with the Preschool's Facility Representative Maria Nugent and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Children's Personal Rights, and Child Car Seat Law were observed to be posted. Operating days and hours are Monday-Friday 08:30 AM to 04:00 PM.

LPA observed 11 children and 2 staff, Maria during inspection today. LPA inspected the building inside and out with Maria. The Preschool is located on a Church site. The Preschool classroom, restrooms, Office, Storage Room and area, and food Preparation areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children to use were observed to be in operating conditions. Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides morning and afternoon snacks. Food storage area was inspected. Menu was posted. Trash can for solid waste had tight fitting covers on.

Outdoor activity space was enclosed by fence. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Maria. stated that facility does not have weapons on the premises. Drinking water was arranged to be readily available to children. Shade is provided by trees. First Aid kit was inspected. Smoke and Carbon Monoxide Detectors were tested and proved to be functioning. Facility's fire/disaster drill log recorded that the last drill was conducted on 8/2/2022
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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 5
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: GLORIA DEI EARLY LEARNING CENTER
FACILITY NUMBER: 434408823
VISIT DATE: 10/04/2022
NARRATIVE
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Outdoor activity space front and back were fully enclosed by fence. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Teacher Maria N. stated that facility does not have weapons on the premises. Drinking water was arranged to be readily available to children. Shade is provided by trees. First Aid kit was inspected. Smoke and Carbon Monoxide Detectors were tested and proved to be functioning. Fully charged fire extinguishers were observed Facility's fire/disaster drill log recorded that the last drill was conducted on 8/2/2022.

A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPAs reminded Teacher Maria N. that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPAs' inspection.


Facility representative Maria Nugent was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GLORIA DEI EARLY LEARNING CENTER
FACILITY NUMBER: 434408823
VISIT DATE: 10/04/2022
NARRATIVE
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LPA reviewed with facility representative Maria Nugent the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Facility's Incidental Medical Services (IMS) policy was discussed with Teacher Maria N. 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/childqanda.htm.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection



A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

Exit interview conducted and report was reviewed with facility representative Maria Nugent .

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/04/2022 08:08 PM - It Cannot Be Edited


Created By: Stephanie Collins On 10/04/2022 at 01:33 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: GLORIA DEI EARLY LEARNING CENTER
FACILITY NUMBER: 434408823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022

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 reviews, the licensee did not comply with the section cited above in [2] out of [3 [Tdap and MMR] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2022
Plan of Correction
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Staff member: Mary De Hart will submit Proof of Immunization against Tdap and MMR on or before POC date
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 in [1] out of [1] Mandated Reporter Training for Maria Nugent - which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2022
Plan of Correction
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Facility Representative : Maria Nugent will submit proof of completion of the Mandated Reporter Training on or before POC date.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Stephanie Collins
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/04/2022 08:08 PM - It Cannot Be Edited


Created By: Stephanie Collins On 10/04/2022 at 01:33 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: GLORIA DEI EARLY LEARNING CENTER
FACILITY NUMBER: 434408823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(6)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, training and/or experience specified in this chapter.

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 in [3] out of [2] LIC 501 Personnel Record which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2022
Plan of Correction
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Mary DeHart Teachers Assistant: will submit an updated LIC 501 Personnel Record/
fully completed with times and dates and submit supportive documentation (Transcripts) and Proof of Registration in educational institution.
Section Cited
Personnel Records
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Stephanie Collins
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
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