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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415313
Report Date: 10/27/2021
Date Signed: 10/27/2021 03:22:03 PM

Document Has Been Signed on 10/27/2021 03:22 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:SPRINGS OF LIFE CHRISTIAN PRESCHOOLFACILITY NUMBER:
434415313
ADMINISTRATOR:DENHOLM, JULIEFACILITY TYPE:
850
ADDRESS:3151 UNION AVENUETELEPHONE:
(408) 827-5814
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 36DATE:
10/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Julie Denholm and James AndersonTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection today and met with owner/director Julie Denholm and member of the board, James Anderson. The day care center is licensed for 45 preschool children in rooms 4, 5, 6 and 7. Room # 6 is currently not being used. The days and hours of operations are Monday - Friday from 7:00am to 6:00pm. LPA observed the required posted materials which includes 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), Menus, and Activity Schedule are posted prominently.

A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA reviewed ten (10) children's files during today's inspection. Children's records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report and Immunization Record.

LPA reviewed five (5) staff files. Staff records reviewed include Criminal Record Clearance, Statement Acknowledging Requirement to report Child Abuse, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education.

REPORT CONTINUED ON THE FOLLOWING PAGE
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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: SPRINGS OF LIFE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434415313
VISIT DATE: 10/27/2021
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LPA toured the facility with the Director. The learning and activity areas were observed to be clean and in good order. Furniture and play equipment were observed to be age appropriate and in good condition. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Children's restroom is clean and in good operating condition. .Facility provides morning and afternoon snacks. The children pack their own lunches from home and are properly stored in their lunch bags with ice packs. First aid kit, fire extinguishers, smoke and carbon monoxide detectors were observed in the facility. Director stated that facility does not have poisons, weapons and ammunition on the premises. Trash cans for solid wastes have tight-fitting covers on.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There are sufficient resilient material in the outdoor playground area. There are no hazardous materials or bodies of water observed.

Per Director, they currently do not provide Incidental Medical Services. 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/childqanda.htm.

LPAs also discussed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Site Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

As a result of this inspection, there were no deficiencies cited. A copy of this report was provided to the Director.

NOTICE OF SITE VISIT WAS ISSUED. 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: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
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