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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709941
Report Date: 11/29/2022
Date Signed: 11/29/2022 01:11:55 PM


Document Has Been Signed on 11/29/2022 01:11 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:ROSE CHILD DEVELOPMENT CENTER - SCHOOL AGEFACILITY NUMBER:
430709941
ADMINISTRATOR:KATHLEEN LINCOLNFACILITY TYPE:
840
ADDRESS:250A ROSWELL DRIVETELEPHONE:
(408) 635-2686
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:33CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Alicia PadillaTIME COMPLETED:
01:15 PM
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On Tuesday, November 29, 2022 at 9:10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required One (1) Year Visit. LPA met with the Interim CDC Coordinator Alicia Padilla and Head Teacher Lorena Wright and explained the purpose of the visit. The School Age Program is operated by the Milpitas Unified School District and all the Staff Criminal Background checks are manage by the Department of Education.

The School Age Program opens end of the school day at 2 pm until 5:30 p.m., Monday to Friday in Portable Room G.

LPA toured the facility to conduct a Health and Safety Inspection with the Head Teacher Lorena Wright. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Menus and LIC 613A Personal Rights were observed to be posted. There were no bodies of water observed. Site Supervisor stated that facility do not have weapons on the premises. Furniture and equipment were in good condition, free of sharp, loose, or pointed parts. Restrooms for children’s use were observed to be in safe and sanitary operating conditions. Floors were clean and safe, and outdoor activity space were free of hazards. Playground equipment was in good condition. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to children were stored inaccessible to children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
See 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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: ROSE CHILD DEVELOPMENT CENTER - SCHOOL AGE
FACILITY NUMBER: 430709941
VISIT DATE: 11/29/2022
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Continuation.

Facility files were reviewed. A sampling of Children's files was taken for review. Snack is being provided by the School.

LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations, fire extinguishers and sprinkler system. Fire and Earthquake Disaster Drills conducted on 10/26/2022. Facility does not provide transportation for children.

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.

LPA discussed the Lead Testing and Prevention Information to Interim Coordinator Alicia Padilla. LPA obtained copies of Staff Sign in List and Child Care Facility Roster.

There are no deficiencies cited on this visit.

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



Exit interview conducted and report was reviewed with the Interim Coordinator, Alicia Padilla.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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