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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700549
Report Date: 12/10/2019
Date Signed: 12/10/2019 12:11:47 PM

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:SAN JOSE DAY NURSERYFACILITY NUMBER:
430700549
ADMINISTRATOR:ELENA JOLLYFACILITY TYPE:
850
ADDRESS:33 NORTH 8TH STREETTELEPHONE:
(408) 288-9667
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:88CENSUS: 50DATE:
12/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elena JollyTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Shannel Reed met with Executive Director, Elena Jolly, for an unannounced annual/random inspection today and informed her of the purpose of today’s inspection. LPA toured the facility both inside and outside during today’s visit. LPA observed the required posted materials, including 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 (includes current and following weeks), and Activity Schedules. The teacher/child ratio was in compliance during today’s visit. LPA observed 50 children with 12 teaching staff (6 Teachers and 6 Aides).

LPA reviewed six (6) children’s files. LPA observed the Immunization's, Information and Emergency Information form (LIC 700) and additional documentation is complete.

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 reviewed seven (7) Teacher files. All Teachers have a current CPR and First Aid Certifications on file. The Executive Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). The Executive Director understands the conditions, limitations, and capacity specifications of the Facility license. The Executive Director understands that children shall be visually supervised at all times. LPA observed that the Immunization's against Measles, Pertussis and Influenza (or an opt-out statement) and the required Mandated Reporting Training (AB1207) are completed and on file for each teacher.

LPA observed that the classrooms are clean and safe for all children and staff. Drinking water is readily available for the children inside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classroom and in the playground area.
Facility Evaluation Report dated 12/10/19 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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 2
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: SAN JOSE DAY NURSERY
FACILITY NUMBER: 430700549
VISIT DATE: 12/10/2019
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Facility Evaluation Report dated 12/10/19 continued from previous page:
The Executive Director states that there are no weapons on the premises. Lunch and snacks are provided by the facility. Lunch is prepared in the on-site kitchen. LPA toured the on-site kitchen and observed the food preparation area is adequately equipped with ovens, stoves, a refrigerator which stores food at 45 degrees or below, and hot and cold running water. LPA observed a garbage can with a tight fitting lid in the kitchen area. There is also adequate food for snacks and regular meals for the children. Cleaning supplies are stored inaccessible to the children. Any medications at the center are stored in a lock box in the front office. First Aid kit is stored in the classroom, out of reach of the children.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. Drinking water is available outside via a water fountain. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed no bodies of water.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised the Executive Director of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed and provided Lead Safety information (AB 2370).

LPA obtained a Facility roster and conducted an exit review with the Executive Director.
No Title 22 Deficiencies were observed during today’s inspection.


A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
LIC809 (FAS) - (06/04)
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