430702131-5-18-2023-07-CC-PHEZ-CRXSXD-20230518141545

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430702131
Report Date: 05/18/2023
Date Signed: 05/18/2023 02:15:51 PM

Document Has Been Signed on 05/18/2023 02:15 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:	EAST VALLEY CHRISTIAN PRESCHOOL		FACILITY NUMBER:	430702131
ADMINISTRATOR:	CHRISTINE BELTRAN		FACILITY TYPE:	850
ADDRESS:	2715 SOUTH WHITE ROAD		TELEPHONE:	(408) 270-2560
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	144	CENSUS: 57	DATE:	05/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Christine Beltran		TIME COMPLETED:	02:30 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) Pete Hernanez conducted an unannounced annual random inspection. LPA met with Director Christine Beltran and explained the reason for the inspection. Facility is located on East Valley United Pentecostal Church. LPA observed: Rm 1 Pre-Kinder 2 Teachers and 24 children Rm 2 Preschool 2 Teachers and 21 children Rm 3 Currently not in use Rm 4 Preschool 2 Teachers and 12 children Teacher Ratios were in compliance. Present during the beginning of the inspection were 57 preschool children and 6 staff. Children were under the visual supervision of teachers. LPA reviewed sign in/sign out sheet, which contains full signature of authorized representative. License, Parent’s Rights, and Emergency Disaster Plan were observed to be posted. The facility was toured inside and outside with Director. The facility observed to be clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. The furniture and the equipment, such as tables, chair, and napping cots, were age-appropriate and in good condition; free of sharp or loose, or pointed parts. The floors were clean and free of tripping hazard. LPA observed there is sufficient amount of age-appropriate toys for children in care. Restrooms for children’s use were observed to be safe, sanitary, and in functioning condition. Director stated that there are no weapons stored on the premise.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

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: EAST VALLEY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 430702131
	VISIT DATE: 05/18/2023

NARRATIVE

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All snacks and meals are prepared and brought from home. Drinking water is provided through water bottles, drinking fountains, and water pitchers and cups.

The outdoor activity area is fenced. The playground equipment outside were maintained in safe condition, free of sharp, loose or pointed parts. Areas around play structures were cushioned with resilient materials to absorbs falls. The facility shares outdoor activity with the private elementary school on site. Shaded rest areas are provided through building overhang. LPA did not observe any bodies of water.

LPA observed functioning fire extinguisher, carbon monoxide detector, and smoke detectors. Fire/emergency drill was last conducted on 5/11/23.

Facility roster was reviewed and was copy was obtained.10 children’s files were taken for review during today’s inspection. The records reviewed contained all the required documentation.

Staff present during the inspection have cleared criminal record and child abuse index clearance or exemption. LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

There is currently at least one staff on site with valid CPR/First Aid,. 6 staff files were reviewed. The records reviewed include but not limited to immunization (Measles, Pertussis, and Influenza), Mandated Reporter Training (AB 1207), and education credit. LPA observed that staff did not have immunization records for pertussis and measles in file.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

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: EAST VALLEY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 430702131
	VISIT DATE: 05/18/2023

NARRATIVE

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LPA discussed Senate Bill 792 (immunization records for pertussis, measles, and flu vaccines), which began in 2016 for anyone working with the children and Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

Director stated that she currently does not have a child in care who requires Incidental Medical Services (IMS) services. IMS plan is in file. Medication is stored in a container, which is located in cabinet and with the proper documents. IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, An exit interview was conducted, A copy of this report was discussed and left with the Licensee, Christine Beltran, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

LIC809 (FAS) - (06/04)

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