430709268-4-6-2023-07-CC-AMOS-CQMT5X-20230406142613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709268
Report Date: 04/05/2023
Date Signed: 04/06/2023 02:26:21 PM

Document Has Been Signed on 04/06/2023 02:26 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:	LOTUS PRESCHOOL		FACILITY NUMBER:	430709268
ADMINISTRATOR:	LYNNE YAMAICHI		FACILITY TYPE:	850
ADDRESS:	639 NORTH FIFTH STREET		TELEPHONE:	(408) 293-1612
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	24	CENSUS: 16	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Lynne Yamaichi		TIME COMPLETED:	11:30 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 Analyst (LPA ) Anna Morales conducted an ANNUAL REQUIRED visit and was greeted by Director Lynne Yamaichi. The preschool is licensed in Classrooms Dharma(Classroom One) and a Part- time classroom (Classroom Two). The Dharma classroom is a full-time classroom. The Part Time classroom is opened Monday-Friday. Hours of operation are :7:30-5:30pm, Monday to Friday. Last Disaster Drill was conducted on 2/23/23. LPA observed 16 students and three teachers and one teacher's assistant in the play ground/patio. Facility was observed to be in compliance with teacher to child ratio requirement during visit. LPA observed age appropriate furnishings in the classrooms. Observed Carbon monoxide and smoke detectors and charged Fire extinguisher. Director stated that facility does not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible Floors were clean. 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) There are cubbies for the children to place their belongings. Observed the sign in and sign out procedure. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed play equipment were in good condition. Observed resilient materials under the climbing structures. The children bring their own water bottles, and the school will offer more if needed. Activities schedule were posted. Facility provides snacks (morning and afternoon). LPA observed that food storage areas were clean and free of litter.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: LOTUS PRESCHOOL	FACILITY NUMBER: 430709268
	VISIT DATE: 04/05/2023

NARRATIVE

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This facility is providing Incidental Medical Services – IMS Plan. LPA observed that the medications are stored and inaccessible to the children. LPA reviewed supporting documentation of the Children's Centrally Stored Medications. For 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 (TYY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/chidlqanda.htm

LPA reviewed a random selection of children files. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, Immunization.

LPA reviewed Staff's records include Criminal Record and Child Abuse Index Clearance, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPA reminded Owner that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA also 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.

LPA discussed the requirements of AB 633 and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: LOTUS PRESCHOOL	FACILITY NUMBER: 430709268
	VISIT DATE: 04/05/2023

NARRATIVE

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Exit interview conducted and report was reviewed with the Director Lynne Yaimachi.

No deficiencies cited at today's visit.

NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

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/inspection-process

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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