434412005-1-29-2025-07-CC-MMOO-DDDVWN-20250129154813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412005
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:48:21 PM

Document Has Been Signed on 01/29/2025 03:48 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:	ST. JOSEPH OF CUPERTINO PRESCHOOL		FACILITY NUMBER:	434412005
ADMINISTRATOR/ DIRECTOR:	CHEN, CELINE		FACILITY TYPE:	850
ADDRESS:	10120 NORTH DE ANZA BLVD.		TELEPHONE:	(408) 252-9778
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 10	CENSUS: 7	DATE:	01/29/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Celine Cheng		TIME VISIT/ INSPECTION COMPLETED:	03:55 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 (LPAs) Marilou Monico and Darnella Barnes met with Site Director, Celine Cheng, for an unannounced Annual Random Inspection. The purpose of today's inspection was explained with Celine. LPAs observed all the required postings. The center's operating hours are Monday through Friday from 8:00 AM to 5:30 PM. The facility is licensed to serve children ages 3 years to entry into kindergarten. The preschool program has active waivers: to share the playground with the St. Joseph of Cupertino School, to allow the preschool children to share the Library with the St. Joseph Elementary School children at different times and to allow incidental use of the Church, Parish Hall, and Multi-Purpose Room. LPAs toured the indoor and outdoor areas. LPAs observed that the teacher-child ratio was in compliance. Fire drill was conducted on October 23, 2024. The facility has current children's roster. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. The parents provide snacks and lunch to the children. Drinking water is available for the children via drinking fountains and individual water bottles. LPAs observed trash cans with tight fitting covers for the disposable of solid waste. The facility has the required size fire extinguisher and working smoke and carbon monoxide detectors. Celine stated that there are no weapons or firearms on the premises. LPAs reviewed 10 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Parent Right's Receipt, Physician's Report with tuberculosis test, Child's Preadmission Health History, Immunization Record, and Personal Rights. Four children (C1 thru C4) are missing the result for tuberculosis test. *Continuation on next pages:*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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: ST. JOSEPH OF CUPERTINO PRESCHOOL	FACILITY NUMBER: 434412005
	VISIT DATE: 01/29/2025

NARRATIVE

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LPAs reviewed a staff file. 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. LPAs completed one Evaluation of Teacher Qualifications (LIC 9095). LPAs reminded Celine 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Site Director, Celine Cheng, 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).

LPAs verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.

Continuation on next page:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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: ST. JOSEPH OF CUPERTINO PRESCHOOL	FACILITY NUMBER: 434412005
	VISIT DATE: 01/29/2025

NARRATIVE

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Site Director, Celine Cheng, 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, Type B deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Site Director, Celine Cheng.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/29/2025 03:48 PM - It Cannot Be Edited

Created By: Marilou Monico On 01/29/2025 at 02:51 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: ST. JOSEPH OF CUPERTINO PRESCHOOL	FACILITY NUMBER: 434412005
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(b)(2)

Child's Medical Assessments

(b) The medical assessment shall provide the following: (2) Results of a test for tuberculosis. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, four children (C1, C2, C3, and C4) are missing the TB test which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/19/2025
	Plan of Correction
1 2 3 4	Site Director states that she will submit proof of tuberculosis test for the four children by 02/19/25.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Joel Segura

LICENSING EVALUATOR NAME:

Marilou Monico

LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC809 (FAS) - (06/04)

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