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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709420
Report Date: 06/14/2021
Date Signed: 06/14/2021 12:55:44 PM

Document Has Been Signed on 06/14/2021 12:55 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
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: 180TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
01:00 PM
NARRATIVE
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On Monday, June 14, 2021 10:35 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit, following an Unusual Incident occurred on 05/27/2021. Unusual Incident Report LIC 624 received via fax on 05/28/2021. LPA met with Teacher Christine Fennel (Personnel In Charge), Director Sheila Tanimura is on a time off today. Present on this visit were 63 preschool children and 14 Staff (Teacher and Aide).

LPA toured the facility. LPA conducted staff interviews. LPA obtained copies of the facility's Staff Roster and Children’s Roster. LPA reviewed records of the staff and a child in care.

Based on the Unusual Incident reported and Staff interviews, on 05/27/2021, at around 3:15 PM, a preschool child was left unattended in the playground area. Absence of supervision is being cited today. 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 06/21/2021. Civil penalty of $500.00 has been assessed today and $100.00 per day if not corrected by the POC due date of 06/21/2021. Any violation of this serious nature within the next 12 months will be immediately a $1000.00 civil penalty and $100.00 per day until corrected.

Christine Fennel 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.
See 809 C for continuation.....
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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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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: 06/14/2021
NARRATIVE
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An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the Licensee. Notice of Site Visit was posted.

The attached Civil Penalty Assessment - Immediate $500 was cited during this inspection. The appeals rights were provided. A copy of this report was also provided and is to be kept in the facility records for a period of three years.

A NOTICE OF SITE VISIT WAS PROVIDED. IT MUST BE POSTED NEAR THE FACILITY'S FRONT ENTRANCE AND MUST REMAIN POSTED FOR 30 DAYS.

LPA provided information guidance of the following web links that can be included on a Staff training;

https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/
https://ccld.childcarevideos.org/child-care-center-operators/what-is-a-civil-penalty/
https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/

End of Report.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/14/2021 12:55 PM - It Cannot Be Edited


Created By: Manel Estoesta On 06/14/2021 at 12:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MILPITAS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430709420

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2021
Section Cited
CCR
101229(a)(1)

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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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The Director should document in wriitng of a Staff Training focusing on Children Supervision. The training should be llogged and will be submitted to LPA on or before the POC date 06/21/2021.
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Based on interviews and record review, the teachers did not ensure the preschoold child was accounted for prior to going inside and was unsupervised for 1-2 minutes. This poses an immediate risk to the health and safety of children in care. An Immediate Civil penalty of $500 assessed.
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 A non-compliance conference and or meeting will be scheduled at a later date.

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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 Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2021


LIC809 (FAS) - (06/04)
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