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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416233
Report Date: 04/17/2024
Date Signed: 04/17/2024 05:28:56 PM

Document Has Been Signed on 04/17/2024 05:28 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:CENTENARY ACADEMYFACILITY NUMBER:
434416233
ADMINISTRATOR/
DIRECTOR:		ELDA LIUFACILITY TYPE:
850
ADDRESS:383 SPAR AVENUETELEPHONE:
(408) 636-8966
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 15DATE:
04/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Elda LiuTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Andrea Cortez conducted an unannounced Annual/Random inspection. LPA met with Licensee/Director Elda Liu and explained the reason for the inspection. Present during today's inspection were 16 children and three staff.

There is a board to post required postings, such as license and notification of parent's rights. LPA discussed with Licensee that car seat and personal rights also need to be posted. The hours of operation are Monday through Friday 8AM to 6PM. Facility uses an electronic sign in/out. LPA discussed with Licensee that parents need to sign in and out and sign their legal signature.

LPAs toured the inside and outside of the center with Licensee. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide. The last fire drill was conducted on 02/2024. Licensee stated that there are no weapons stored on the premise.

The outside area is fenced. LPA observed that there are panels on the fence that shifted causing there to be gaps in the fence. There is a climbing structure and a tunnel that is elevated off the ground that does not have resilient material underneath. The climbing structure is also not anchored to the ground. Shaded rest area is provided through covered patio and trees. There were no bodies of water observed during today's inspection.

-----------------continues on 809 dated 04/17/2024 page 2--------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233
VISIT DATE: 04/17/2024
NARRATIVE
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Meals are prepared and brought from home. Facility only provides snacks to children. Drinking water is provided through Brita filter and individual water bottles. Menu was observed to be posted. Kitchen used to prepare snacks has hot and cold running water.

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.
Facility has not completed the lead testing. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records. LPA discussed with Licensee to ensure that any children who are not enrolled to have their parents pick up their medication. For IMS information see PIN 22-02-CCP. 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-carecenters/.

A copy of the facility roster was obtained. Five (5) children's files were reviewed. The records reviewed include but not limited to immunization records and admission agreement. C-1 did not have immunization records or the LIC 701 on file.

Two staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter training. All staff do not have Mandated Reporter training certificate on file. S-1 does not have any documents/forms on file. S-2 is missing Health Screening, TB test, immunization records, and transcript. Licensee has a valid CPR/1st Aid, which expires on 05/06/2025.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233
VISIT DATE: 04/17/2024
NARRATIVE
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All staff present have cleared criminal records, child abuse, or exemption. Licensee 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.

At 12:37PM, LPA observed that there was a child in Room 1 who was behind the bookshelf. Staff were in Room 2 where they cannot visually supervise child. Licensee came into the room and brought the child to the Room 2. At 2:49PM, LPA observed that children were going into the restroom in Room 1. There was no staff positioned where they can visually supervised the children inside the restroom.

Licensee will submit the following:
- S-1's paperwork and forms
- S-2's transcript, Mandated reporter training, immunization record for measles, pertussis, influenza, Health Screening, and TB test
- C-1's immunization records and Physician's report
- resilient material under climbing structures
- proof that fence is fixed
- lead testing appointment and LIC 9275, LIC 9276, and LIC 999 once testing is completed
- sign in for 04/17/2024 that shows parent's legal signature

As a result of this inspection, Type A and Type B citation were issued. Exit interview was conducted and report was reviewed with Licensee Elda Liu. A notice of site visit has been issued and must remain posted for 30 days.
----------------continues on 809 dated 04/17/2024 page 4---------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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Document Has Been Signed on 04/17/2024 05:28 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 03:37 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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.1(c)(1)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on record review, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. S-1 did not have a copy of transcript on file.
POC Due Date: 04/24/2024
Plan of Correction
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By POC 04/24/2024, Licensee will submit proof that S-1 is obtaining transcript and will send transcript to Licensing. Licensee understands that S-1 cannot be considered a fully qualified teacher until she is able to obtain proof that S-1 has completed at least 12 semester units.
Type A
Section Cited
CCR
101216.3(b)(1)
Teacher-Child Ratio
(b) The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1) A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).

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, which poses an immediate health, safety or personal rights risk to persons in care. S-1 did not have transcript on file to qualify that they are fully qualified.
POC Due Date: 04/24/2024
Plan of Correction
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By POC 04/24/2024, Licensee will submit written plan on how she will ensure the center is ratio and submit staff schedule with transcript.
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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


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Document Has Been Signed on 04/17/2024 05:28 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 03:37 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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Testing for lead was no completed.
POC Due Date: 04/24/2024
Plan of Correction
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By POC 04/24/2023, Licensee will submit proof that lead testing is schedule and submit the following documents, LIC 9275, LIC 9276, and LIC 999 upon completion.
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is no resilient material below climbing structures and tunnel.
POC Due Date: 04/24/2024
Plan of Correction
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By 04/24/2024, Licensee will submit proof of purchase of resilient material and proof once it installed.
Licensee stated that she will remove climbing dome and submit proof to Licensing.
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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


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Document Has Been Signed on 04/17/2024 05:28 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 03:37 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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(g)
Outdoor Activity Space
(g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There are gaps in the fence.
POC Due Date: 05/01/2024
Plan of Correction
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By POC 05/01/2024, Licensee will fix gaps in the fence and sent proof to Licensing.
Type B
Section Cited
CCR
101239(o)
Fixtures, Furniture, Equipment and Supplies
(o) Playground equipment shall be securely anchored to the ground unless it is portable by design.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Climbing structure is not anchored to the ground.
POC Due Date: 04/24/2024
Plan of Correction
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By POC 04/24/2024, Licensee stated that she will removed the climbing dome and submit proof to Licensing.
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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


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Page: 6 of 10
Document Has Been Signed on 04/17/2024 05:28 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 03:37 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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed that children were going into the bathroom. There was no staff present where they can visually supervise children. LPA also observed that a chid was in Room 1. Staff were in Room 2 and cannot see child in Room 1.
POC Due Date: 04/24/2024
Plan of Correction
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By POC 04/24/2024, Licensee will do training with staff and submit proof meeting notes and list of staff who attended training.
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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4
Based on record review, the licensee did not comply with the section cited above in three out of three persons, which poses a potential health, safety or personal rights risk to persons in care. All staff do not have Mandated Reporter training certificate on file.
POC Due Date: 06/03/2024
Plan of Correction
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2
3
4
By POC 06/03/2024, all staff will complete Mandated Reporter training and submit certificate to Licensing.
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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


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Document Has Been Signed on 04/17/2024 05:28 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 03:37 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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024

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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of three persons, which poses a potential health, safety or personal rights risk to persons in care. S-1 and S-2 do not have immunization record on file.
POC Due Date: 04/24/2024
Plan of Correction
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2
3
4
By POC 04/24/2024, Licensee submit immunization record for S-1 and S-2 to Licensing.
Type B
Section Cited
CCR
101217(a)(12)
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: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of three persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2024
Plan of Correction
1
2
3
4
By POC 04/24/2024, License will submit proof that S-1 and S-2 are completing TB test and send test results upon completion.
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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


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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: CENTENARY ACADEMY
FACILITY NUMBER: 434416233
VISIT DATE: 04/17/2024
NARRATIVE
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---------------------continuation of 809 dated 04/17/2024 page 3------------------

LPA Samantha Yip informed Licensee, Elda Liu, that this report dated 04/17/2024 document(s) two Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Licensee to provide a copy of this licensing report dated 04/17/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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