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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709420
Report Date: 12/03/2021
Date Signed: 12/03/2021 12:42:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MILPITAS CHRISTIAN PRESCHOOLFACILITY NUMBER:
430709420
ADMINISTRATOR:SHEILA TANIMURAFACILITY TYPE:
850
ADDRESS:1000 S. PARK VICTORIA DRIVETELEPHONE:
(408) 945-6530
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:180CENSUS: 94DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Sheila TanimuraTIME COMPLETED:
01:00 PM
NARRATIVE
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On Friday, December 3, 2021 at 10:19 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Case Management Visit. LPA met with the Facility Representative - Director Sheila Tanimura and explained the nature of site visit. Present on this visit were 94 preschool children and 19 staff. Facility operates from Monday to Friday 7:30 am to 6pm.

At 10:45 am LPA toured the facility with the Director. At 10:55 am, LPA conducted staff interviews.

Unusual Incident Reported by the Director on 11/23/2021 at 1:03pm via a phone call to the Regional Office. A completed LIC 624 emailed to LPA on 11/24/2021 at 10:54am.

Based on the staff interviews, on 11/23/2021, at approximately 11:45 am, a group of preschool children with 2 staff just finished the outdoor play. When the group transitioned back to the classroom, one of the preschool child left behind at the playground. Another teacher from a different classroom, saw the child sitting on the grass area and brought the child back the child's classroom.

Absence of supervision is being cited today and this is a repeat violation. Lack of supervision poses an immediate risk to children in care and it is a Type A deficiency, which must be corrected by the Plan of Correction (POC) due date of 12/31/2021.

The following dates were the facility had the same violation;
1. 06/14/2021
2. 07/14/2021

See 809 C for continuation...
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MILPITAS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430709420
VISIT DATE: 12/03/2021
NARRATIVE
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Continuation...........

LPA discussed the Plan of Correction.

The director acknowledges that upon receipt of a Type A deficiency, the Licensee shall post the LIC 809-D with the Type A deficiency for 30 days. Further, because a Type A deficiency was cited during this visit, the Licensee must provide a copy of this report to all parents, as well as newly enrolled parents, for the next 12 months. Additionally, form LIC 9224 (Acknowledgment of Receipt of Licensing Reports) must be signed by each existing parent and newly enrolled parent and a copy of that signed LIC 9224 form be placed in each child's file during the next 12 months.

LPA discussed to the Director that LPA will process a Technical Support Program Referral to the facility. It is a free service that offers intense onsite support to Child Care Providers. The Director understood.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Sheila Tanimura.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MILPITAS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430709420
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/03/2021
Section Cited

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THIS IS AN AMENDED 809 D.
CCR 101229 (a)(1)No child(ren) shall be left without the supervision,
including visual supervision, of a teacher at any time......
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Based on staff interview, staff did not ensure the preschoold child was accounted for when transitioning from outdoor play back to the classroom.
This poses an immediate risk to the health and safety of children in care. An Immediate Civil penalty is being assessed for a repeat violation.
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LPA recommended the CDSS Child Care Videos to use for the Staff Meeting or training. LPA also will recommend the facility for a TSP. Director understood.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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