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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710153
Report Date: 02/04/2025
Date Signed: 02/04/2025 04:20:29 PM

Document Has Been Signed on 02/04/2025 04:20 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HOLY CROSS LUTHERAN CHILDREN'S CENTERFACILITY NUMBER:
430710153
ADMINISTRATOR/
DIRECTOR:		FEHRENBACH, CYNTHIAFACILITY TYPE:
840
ADDRESS:15885 LOS GATOS - ALMADEN ROADTELEPHONE:
(408) 356-6828
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 54DATE:
02/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Cynthia FehrenbachTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Director, Cynthia Fehrenbach, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by the Director and toured both indoors and outdoors during the inspection. Upon arrival, there were 54 school-age children and 5 teachers and 4 aides present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday 6:30AM-8:00AM for the morning session and the afternoon session is Wednesday 1:15PM - 6:00 PM and Monday, Tuesday, Thursday and Friday 2:30-6:00 PM.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. All staff persons present had criminal record clearance and were associated to the facility roster on Guardian.

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire/disaster drill was conducted on 02/03/2025, which is compliant with the six month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher last serviced 01/16/2025, which is compliant with state fire marshal regulations. LPA observed a fully functioning smoke detector system and a working carbon monoxide detector.

Director states that she does have children in care who require Incidental Medical Services.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
Continued on Page 2
Joel SeguraTELEPHONE: (408) 334-8550
Jennifer BeehlerTELEPHONE: (408) 324-2148
DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HOLY CROSS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 430710153
VISIT DATE: 02/04/2025
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LPA observed the medication locked in a cabinet in the off limits area of the Director's office. LPA observed 2 medications that expired in August of 2024. Director removed the medication during the inspection and stated she would release it back to the parent's during pick up.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via water fountains and each child has water bottles from home labeled with the children’s names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children. The Director has a working telephone in the facility. Cleaning and maintenance for the facility is conducted by an outside service and is completed in the evenings after all day care children have left the premises. The Director states that there are no weapons or firearms on the premises.

The outdoor area of the facility was inspected and observed to be fenced in. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy, building overhang and trees. The play equipment was labeled with an age range of 5-12 years old.

Food is provided by the facility and is stored, prepared, and served in a safe and healthful manner to the children. Facility offers an afternoon snack to children. Menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use. LPA observed milk in the refrigerator to expire on 02/07/2025.

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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HOLY CROSS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 430710153
VISIT DATE: 02/04/2025
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10 children’s files (school-age) were reviewed during today’s inspection for the following records: Physician’s Report (LIC701), Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Signed Admission Agreement, and proof of enrollment into a school to confirm immunization records. LPA observed 10/10 children's files were missing LIC701. LPA provided a black copy to the facility to add to their admissions package for children in care.

5 staff files (3 Teachers/ 1 Aide / 1 Director) were reviewed for the following records: Transcripts/Verification of Experience, Health Screening Report (LIC503), Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, Tuberculosis (TB) Clearance, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). There is at least one staff member present with current CPR/First-Aid that expires 01/11/2027. The Director has current Mandated Reporter Training that expires on 03/27/2026. LPA reminded Director that the Mandated Reporter Training must be renewed by all staff every 2 years and that the class must satisfy the requirement for AB1207.

The Director understands that the site director shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Director that there shall be at least one person with valid CPR and First-Aid certifications on site at all times or present during off site activities, such as field trips.

Due to today's inspection, 2 - Type B Deficiencies were cited, more details provided on the attached LIC809-D. Exit interview conducted with Director Cynthia Fehrenbach, report reviewed and provided to the Director along with appeal rights.

The following documents were collected during today's inspection:
  • Disaster/Emergency Plan
  • Facility Sketch for Facility and Grounds
LPA provided facility with a blank application, administration organization form, physician's report and employee rights documents.

NOTICE OF SITE VISIT WAS PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/04/2025 04:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: HOLY CROSS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 430710153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
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Director to provide photographic evidence of updated Health Screenings to the LPA.
Type B
Section Cited
CCR
101226(e)(2)
Health-Related Services
(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, LPA observed two medications for one child expired on 08/2024. The licensee did not comply with the section cited above in 1 out of 3 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2025
Plan of Correction
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Director to release expired medication to parents of the child in care at the next pick up/ drop off. Director to email LPA confirming the medication is no longer at the facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joel SeguraTELEPHONE: (408) 334-8550
Jennifer BeehlerTELEPHONE: (408) 324-2148

DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025

LIC809 (FAS) - (06/04)
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