<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703695
Report Date: 02/26/2020
Date Signed: 02/26/2020 02:45:31 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:SJB - SAN JUAN BAUTISTA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703695
ADMINISTRATOR:NIKITTIN, YULIANAFACILITY TYPE:
850
ADDRESS:1945 TERILYN AVENUETELEPHONE:
(408) 259-4796
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:231CENSUS: 131DATE:
02/26/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Darlicia BrunerTIME COMPLETED:
03:00 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) Dung Mac conducted an unannounced annual random inspection to the facility today. LPA met with Darlicia Bruner, Site Director, and explained the nature of today's visit to her. The Facility is licensed in rooms P1-P4, P6-P7 for preschoolers and T1A, T1B, T2A, T2B, T3A and T3B for Toddlers.

LPA toured the Facility both inside and outside for today's inspection at 1:15pm. LPA observed all required materials posted. Darlicia states that there are no weapons or firearms on the premises. LPA observed that the teacher/child ratio was in compliance during today's visit. Darlicia understands the conditions, limitations, and capacity specifications of the Facility license. Darlicia understands that children shall be visually supervised at all times.

LPA observed that all rooms are clean and safe for all children and staff. LPA observed all furniture and equipment is in good condition and safe for the children. LPA observed that cleaning products, poisons, and other dangerous items are stored inaccessible to children. LPA also observed that medications are in a safe place inaccessible to children. LPA observed that there is one functioning carbon monoxide in each classroom.

LPA observed that facility provides water bottle for toddlers and each bottle is labelled with child's name. Preschoolers bring their own water bottles. LPA observed child is signed in/out by person responsible for the child. LPA observed solid waste containers with tight-fitting lids in the facility. LPA observed weekly menus posted each classroom. Staff and children's bathrooms are clean. Facility provides breakfast, snacks, and lunch. LPA observed that kitchen and storage areas are clean.

The playground area utilized by children is surrounded by fencing and each playground is gated. LPA observed that outdoor surfaces are safe for the children and outdoor equipment is age appropriate and in good condition. LPA observed canopies and several trees which provide shade for the day care children. LPA did not observe any bodies of water.

Continued on Page #2
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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: SJB - SAN JUAN BAUTISTA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430703695
VISIT DATE: 02/26/2020
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
26
27
28
29
30
31
32
Continued from Page #1

LPA reviewed children's files and staff files at 12:45pm. All staff and children's files were complete. Two staff have current CPR and First Aid certifications on file. Darlicia 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 conducted an exit interview with the Darlicia. No deficiencies were cited during visit. A Notice of Site Visit was issued and must remain posted for 30 days.


SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2