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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702694
Report Date: 02/04/2021
Date Signed: 02/04/2021 02:10:55 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:SHEPHERD OF THE VALLEY LUTHERAN CHURCHFACILITY NUMBER:
430702694
ADMINISTRATOR:TANIA KENNEDYFACILITY TYPE:
850
ADDRESS:1281 REDMOND AVENUETELEPHONE:
(408) 997-4846
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:75CENSUS: 26DATE:
02/04/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Kennedy, TaniaTIME COMPLETED:
02:08 PM
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On this day Licensing Program Analyst (LPA) Almaraz, Celi conducted an unannounced televisit via facetime, due to COVID19 and social distancing guidelines. The purpose of this visit is to go over current RAST procedures at this facility. There are 26 children and 4 qualified staff present for today's televisit. The program currently operates 8:15 AM to 2:45 PM, Monday to Friday. LPA was taken on a guided tour of facility,

PHYSICAL PLANT: This is a preschool program which consists of 5 classrooms. Classrooms: The following was observed of the rooms during this visit: Genesis: There was one teacher/s, with 8 preschool children. Matthew and Mark: There were 14 children and two teacher/s. Luke and John: There were 4 children and one teacher. LPA observed that all children and staff were wearing masks, social distancing, at least 6 feet apart was being practiced. There is a health screening table, with a touch-less thermometer, temperature logs and hand sanitizer at check in. Sign in and Sign out procedures are being done via cell phone. The Director states that in the event that a child is ill while in care, the child's authorized parent/guardian will be called immediately and the child will be isolated in the main office until pick up. Director states that children eat at least 6 feet apart, each child brings their own lunch, individual snacks are provided. Gloves are worn when staff is handling food. Children nap at least 6 feet apart. Each child has their own numbered rest cot. LPA observed cots are separated, blankets are in bins and wrapped in individual plastic, numbered to match the cot. Each child is assigned a their own cot via number.
Director states that furniture and indoor/outdoor equipment, commonly touched surfaces are sanitized as needed, throughout the day. Toilets and sinks are sanitized by staff in between use of each child. Garbage bins have foot petals. Staff and parents have been made aware of adhering to guidelines for sick policies. Director understands the requirements to comply with current Department of Health guidelines and covid19 preventative measures. Director states these guidelines will continue to be followed. There were no citations issued during todays visit. An email copy of this report will be sent to director and acknowledgment is to be sent within 24 hours in lieu of signature and/or scanned and returned. NOTICE OF SITE VISIT ISSUED AND MUST BE POST FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021
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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