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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710433
Report Date: 12/02/2022
Date Signed: 12/06/2022 09:56:56 AM


Document Has Been Signed on 12/06/2022 09:56 AM - 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 PRESCHOOLFACILITY NUMBER:
430710433
ADMINISTRATOR:ROSIE FLORESFACILITY TYPE:
850
ADDRESS:2755 BARKLEY AVENUETELEPHONE:
(408) 423-1117
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:87CENSUS: 15DATE:
12/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Frances O'BrienTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management visit in regards to an Incident that occurred on 11/9/22 approximately at 9:30am in Room 25 ( State Preschool). LPA was greeted by Teacher Frances O'Brien. The hours of operation in Classroom 25 are from 8:15-11:15am.

On 11/9/22, C1 who has allergies to diary was given a snack that had dairy and obtained an allergic reaction. C1 was given medical treatment by staff from School District and parents were notified. Mrs.O'Brien stated that the staff that gave the snack to C1 is from the School District(INCLUSION CLASSROOM/PROGRAM). However, Mrs. Frances O'Brien, stated that C1 is in enrolled in both of the State Preschool and with the School District.

Room 25 is an INCLUSION CLASSROOM, and they share the same hours of operation (8:15-11:15am). Mrs. O'Brien stated that there are eight children enrolled in the INCLUSION CLASSROOM, with one teacher and two educators. She stated that there are ten children enrolled in the State Preschool with one teacher (Mrs. O;Brien) and one teacher assistant.

LPA will continue this Case Management at a later time as it requires further investigation. No deficiencies are being cited at today's visit.

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


SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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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