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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417019
Report Date: 01/23/2025
Date Signed: 01/24/2025 04:24:44 PM

Document Has Been Signed on 01/24/2025 04:24 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:AGNEW DISTRICT PRESCHOOLFACILITY NUMBER:
434417019
ADMINISTRATOR/
DIRECTOR:		GLORIA LOPEZFACILITY TYPE:
850
ADDRESS:3534 ZANKER ROADTELEPHONE:
(669) 369-4185
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 48TOTAL ENROLLED CHILDREN: 32CENSUS: 24DATE:
01/23/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Ivania Rodas and Jennifer MarfiaTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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On 01/23/2025 at 9:10am, Licensing Program Analyst (LPA) Farida Raja arrived to conduct an unannounced Case Management inspection in response to an unusual incident that was self reported by the facility to Licensing on January 16, 2025. The incident occurred on 01/14/2025 involving child, C1. LPA met with the Assistant Director of the Extended Learning Center who informed LPA that both Site Supervisor and Program Manager were in a meeting. LPA met with Site Supervisor, Ivania Rodas and the Program Manager, Jennifer Marfia at 9:50am.

LPA toured the facility and interviewed staff including Director. Based on interviews, it was determined that child, C1 was left unsupervised in the outdoor kitchen area for a few minutes while staff (S1) took another child inside to complete a diaper change. No other staff or children were present outdoors. Staff (S2) was indoors and engaging with parents. Both staff did not have visual supervision of the child while the child was playing outdoors. This poses an immediate risk to the health, safety, and personal rights to children in care.



One Type A deficiency was cited as a result of today’s inspection. An exit interview was conducted, and plan of corrections were reviewed with Site Supervisor, Ivania Rodas.

LPA Raja informed Site Supervisor, Ivania Rodas that this report dated 01/23/2025 documents one 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 Raja informed Site Supervisor to provide a copy of this licensing report dated 01/23/2025 that documents any Type A citation 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.

Appeal rights and LIC 9224 were printed and provided.



A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/24/2025 04:24 PM - It Cannot Be Edited


Created By: Farida Raja On 01/23/2025 at 09:28 AM
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: AGNEW DISTRICT PRESCHOOL
FACILITY NUMBER: 434417019

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2025
Section Cited
CCR
101229(a)(1)

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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 was not met as evidenced by:
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Site Supervisor immediately implemented an action plan, which includes additional training on supervision policies and staff accountability. Topics included were: visibility and headcount, child movement, supervision on the playground, supervision in the classroom, bathroom supervision, phone usage, nap time, check-in / check-out procedures, name-to-face recognition, visual sweeps, two-person integrity, and line of sight supervision. A follow up meeting, including all staff members, has also been schedule on 01/29/2025. Site Supervisor to submit a written plan of correction to LPA by 01/24/2025.
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Based on interviews, it was determined that child, C1 was left unsupervised in the outdoor kitchen area for a few minutes while staff (S1) took another child inside to complete a diaper change. No staff had visual supervision of the child while indoors. This poses an immediate risk to the health, safety, and personal rights to children in care.
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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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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