430710093-11-22-2019-07-CC-SCOS-BJ6RAX-20191122115151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710093
Report Date: 11/21/2019
Date Signed: 11/22/2019 11:51:59 AM

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:	LYNDALE HEAD START		FACILITY NUMBER:	430710093
ADMINISTRATOR:	BRIDGEN, D/DAY, C.		FACILITY TYPE:	850
ADDRESS:	13901 NORDYKE DRIVE		TELEPHONE:	(408) 258-1523
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	48	CENSUS: 30	DATE:	11/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Pedro Sousa		TIME COMPLETED:	05:49 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) Stephanie Collins, conducted an unannounced Annual inspection of the Lyndale Head Start, met with Director Pedro Sousa and informed him the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Children's Personal Rights, and Child Car Seat Law were observed to be posted. Operating days and hours are Monday-Friday 07:00 AM to 06:00 PM. Facility was observed to be in compliance with teacher and adult to child ratio requirement during inspection. LPA inspected the building inside and out. The Head Start is located in Portables 1 and 2 of a functioning school site. The Head starts classroom, restroom for children to use, Office area, Storage area, and food storage areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions. Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides two meals (Breakfast, Snack and Lunch) . Meals are prepared and packaged and is off site, and then deliver to the facility. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on. Activity schedules are posted. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children. Shade is provided by trees, building overhang, etc. First Aid kits were inspected. Smoke and Carbon Monoxide detectors were tested and proved to be functioning.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LYNDALE HEAD START	FACILITY NUMBER: 430710093
	VISIT DATE: 11/21/2019

NARRATIVE

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Fully charged Fire Extinguishers were observed. Log recorded that the last fire/disaster drill was conducted on 10/30/2019. Facility has a Fire Safety & Hazardous Materials Permit effective 10/01/2019, expires on 09/30/2020. LPA reviewed facility's sign in/out procedure and record. A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization. Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

A review of records on 11/20/2019 shows that The Department of Educations completed background checks, criminal record and child abuse index clearances or exemptions.
This facility provides Incidental Medical Services – IMS,does not have any children in care who requires IMS. 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.
LPA reviewed with Director the violations that would result in an immediate $500 fine. Director is encouraged to visit the Department’s website at www.cdss.ca.gov, to access resources for Providers, Regulations etc. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection. Exit interview was conducted, where this report was reviewed with Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

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