430701981-3-21-2023-07-CC-KMEO-CQ5Q7A-20230321115448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430701981
Report Date: 03/21/2023
Date Signed: 03/21/2023 11:54:54 AM

Document Has Been Signed on 03/21/2023 11:54 AM - 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:	WOODHAVEN PRESCHOOL AT WILLOW GLEN UMC		FACILITY NUMBER:	430701981
ADMINISTRATOR:	SMITH, SUSAN		FACILITY TYPE:	850
ADDRESS:	1420 NEWPORT AVENUE		TELEPHONE:	(408) 294-6072
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	48	CENSUS: 38	DATE:	03/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Susan Smith		TIME COMPLETED:	12:15 PM

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 Analyst (LPA) Kassandra Medrano met with Susan Smith, Director, for an unannounced required – 1-year annual inspection. LPA toured the indoor and outdoor areas of the Facility during today's inspection. 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, and Activity Schedule. Days and hours of operation are Monday Wednesday Friday,8:30am-4pm. Tuesday and Thursday 8:30am-2:30pm. The preschool age program is located on campus with Willow Glen Methodist Church. Program is licensed in Rooms: PRE-K 1, 2, & 3, ART ROOM, BLOCK ROOM, AND MUSIC ROOM. LPA reviewed 10 children's and 8 staff files during today's inspection. Each child's file reviewed contains the required documents, including the Information and Emergency Information form (LIC 700) and immunization records. All staff files reviewed contain the required documents, including transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on 3/8/2023. The staff files that were reviewed have current CPR and First Aid certifications on file. Director/Facility Representative 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). LPA observed that the teacher/child ratio was in compliance during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understand that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the office area. LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Facility is currently in the process of remedying a faucet that tested with lead. LPA observed that faucet still covered and not in use by children or staff. The Facility has adequate ventilation, including central air conditioning/heating. Director understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water bubbler in the yard that has been tested and cleared for lead exposure.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WOODHAVEN PRESCHOOL AT WILLOW GLEN UMC	FACILITY NUMBER: 430701981
	VISIT DATE: 03/21/2023

NARRATIVE

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Staff and children's bathrooms are clean, sanitary, and operable. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility.
The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. The Facility only provides snacks to the preschool, As for pre-k children parents provide lunches for the children. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. LPA observed a complete First Aid kit in the Facility, including a touch less thermometer. Director understands that smoking is not allowed on the Facility premises.
This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
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. Shade is provided by trees and building overhangs in the playground. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.
Susan, director, was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Director, Susan. No deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC809 (FAS) - (06/04)

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