430710433-10-19-2022-07-CC-AMOS-CKCQLJ-20221019121601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710433
Report Date: 10/19/2022
Date Signed: 10/19/2022 12:16:28 PM

Document Has Been Signed on 10/19/2022 12:16 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	BOWERS STATE/DISTRICT PRESCHOOL		FACILITY NUMBER:	430710433
ADMINISTRATOR:	ROSIE FLORES		FACILITY TYPE:	850
ADDRESS:	2755 BARKLEY AVENUE		TELEPHONE:	(408) 423-1117
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	87	CENSUS: 24	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rosie Flores/Frances O'Brien		TIME COMPLETED:	12:30 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	LPA Licensing Program Analyst conducted an Annual Required Inspection. LPA was greeted by Director Rosie Flores and Francis O'Brien teacher for classroom Number 25. The Facility is located on the campus of Bowers Elementary School. LPA notes that the State Preschool is licensed in Room 25, 26, & 27 (Title 5) and operates a half day program from 8:15 AM to 11:15am, Monday through Friday during the calendar school year. . LPA was informed that Classroom Number 26 is currently not occupied. The Facility also has an infant program (#434408763) In each of the classrooms, LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. In Classroom 25, there is one sink. The children will utilize the toilets( four) that are located in another building (across the building). 14 students and two teachers In Classroom 27, there is one toilet and two sinks.: 10 students and two teachers Facility was observed to be in compliance with teacher to child ratio requirement during visit. (PAGE 1)

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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

FACILITY NAME: BOWERS STATE/DISTRICT PRESCHOOL	FACILITY NUMBER: 430710433
	VISIT DATE: 10/19/2022

NARRATIVE

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A Fully charged, 2A 10BC Fire extinguishers were observed in the front of the classrooms. The Carbon monoxide detectors are interconnected with the smoke alarms located on the ceilings. Each of the classrooms have refrigerators and cubbies for personal storage. Disinfectants and toxics materials are stored inaccessible to the children. Observed trash bins with tight fitted lids. Each of the classrooms have first aid kits LPA was informed that the parents use a electronic sign in and sign out. . The isolation room is in the main office by the nurses station. This facility is providing Incidental Medical Services – IMS Plan.

LPA observed fully fenced playground area. Observed climbing structures and with materials that observe falls. Shade is provided by canopies The children use there own water bottles, and the water is also provided by the school. Playground is age appropriate.

LPA reviewed a random selection of children files. Children records reviewed include , Identification and Emergency Contact, Medical Assessment and Immunization

LPA reviewed a random selection of Staff records reviewed include Health Screening Report and TB test, and Immunization (Measles, Pertussis, and Flu) record and current Mandated Reporter Training. LPA reminded Staff hat the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA discussed the requirements of AB 633 with the Licensee. Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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

FACILITY NAME: BOWERS STATE/DISTRICT PRESCHOOL	FACILITY NUMBER: 430710433
	VISIT DATE: 10/19/2022

NARRATIVE

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In the areas that were evaluated, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

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

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

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