430700665-1-10-2024-07-CC-SYIP-CZCUD5-20240110142857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700665
Report Date: 01/10/2024
Date Signed: 01/10/2024 02:29:04 PM

Document Has Been Signed on 01/10/2024 02:29 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:	VILLAGE PRESCHOOL		FACILITY NUMBER:	430700665
ADMINISTRATOR:	JACQUELINE ALLEN		FACILITY TYPE:	850
ADDRESS:	20390 PARK PLACE		TELEPHONE:	(408) 867-3181
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	65	CENSUS: 11	DATE:	01/10/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Jaqueline Allen		TIME COMPLETED:	11:45 AM

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) Samantha Yip and Mandeep Kaur conducted an unannounced Required -3 Year inspection. LPA met with Director Jaqueline Allen and explained the reason for the inspection. Present during today's inspection were 11 children and at least two (2) staff. The center was within ratio during today's inspection. There is a board to post required postings, such as license, notification of parent's rights, and car seat law. The hours of operation are Monday through Friday 8:30AM to 2:30PM. LPAs toured the inside and outside of the center with Director. Disinfectant and cleaning supplies were observed to be inaccessible. LPAs observed that there was a knife in the drawers in Room 5/Multi-purpose Room. Director moved knife to an cabinet that is inaccessible during today's inspection. There are toys and equipment for children. Room were observed to be clean and floor were free of tripping hazard. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 11/14/2023. The outside area is fenced. Areas around play structure have resilient material. There were no bodies of water observed during today's inspection. -------------------continues on 809 dated 01/10/2024 page 2------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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: VILLAGE PRESCHOOL	FACILITY NUMBER: 430700665
	VISIT DATE: 01/10/2024

NARRATIVE

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The center does not provide meals and snacks to the children. All meals and snacks are prepared and brought from home. Drinking water is provided through gallon water, cups, and water bottle refill station.

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.

LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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/.

A copy of the facility roster was obtained during today's inspection. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's right and immunization records.

Three (3) staff files were reviewed. The records reviewed include but not limited to education credit and Mandated Reporter training. All staff have a valid CPR/1st Aid, which expires on 06/01/2025.

------------------continues on 809 dated 01/10/2024 page 3--------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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: VILLAGE PRESCHOOL	FACILITY NUMBER: 430700665
	VISIT DATE: 01/10/2024

NARRATIVE

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All staff present have cleared criminal record and child abuse index. Director 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.

An updated LIC 200A, LIC 500, LIC 610, and LIC 308 was obtained during today's inspection.

The center will submit the following:
- LIC 309
- proof that lead testing is scheduled

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Director Jaqueline Allen. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 01/10/2024 02:29 PM - It Cannot Be Edited

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: VILLAGE PRESCHOOL	FACILITY NUMBER: 430700665
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/10/2024

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
1 2 3 4	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. The center has a water bottle refill station that is connected to the water line that was not tested.
	POC Due Date: 02/12/2024
	Plan of Correction
1 2 3 4	By POC 02/12/2024, the center will submit lead test results.

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	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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