<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710433
Report Date: 07/17/2025
Date Signed: 07/17/2025 04:00:02 PM

Document Has Been Signed on 07/17/2025 04:00 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:BOWERS STATE/DISTRICT PRESCHOOLFACILITY NUMBER:
430710433
ADMINISTRATOR/
DIRECTOR:		DAISY CANOFACILITY TYPE:
850
ADDRESS:2755 BARKLEY AVENUETELEPHONE:
(408) 423-1117
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 87TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
07/17/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Daisy Macias Cano/Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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) Anna Morales conducted an unannounced Case Management inspection. LPA met with Site Supervisor Daisy Macias Cano, and explained the purpose of the inspection. LPA reviewed water sample summary and requested Site Supervisor to identify Drinking Faucet in Room 27(Kitchen area,R) with reported Lead Action Level Exceedance of 5.5 parts per billion (ppb) or greater. LPA observed that the faucet was covered with plastic.

Site Supervisor stated that the staff and students never used that fountain. LPA notes that the State Preschool licensed in Room 25, 26, & 27 (Title 5) operates a half day program from 8:15 AM to 11:15am, Monday through Friday during the calendar school year, and is closed during the summer and will reopen on August 4,2025. The District Preschool operates in Room 22(Toddler) Monday through Friday from 7:15am-5:30pm. The 12 children from Room 22, were conducting activities with three qualified staff.

LPA requested Site Supervisor to submit the following facility documents during today's inspection: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), and Facility Sketch (LIC999) labeled with locations of water outlets that were tested.
The water sample conducted by Enthalpy Analytical on 05/17/25 indicated the following: 1) H-Drinking Fountain-Room 27 Kitchen(R)has Lead Action Level Exceedance value of 7.1ppb.

Exit interview was conducted with Site Supervisor and discussed the Type B deficiency and Plan of Correction(POC)that was cited during today's inspection which follows on the next page. Appeal Rights given. LPA issued a Notice of Site Visit and informed Site Supervisor to post in a visible location for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 3
Document Has Been Signed on 07/17/2025 04:00 PM - It Cannot Be Edited


Created By: Anna Morales On 07/17/2025 at 10:44 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BOWERS STATE/DISTRICT PRESCHOOL
FACILITY NUMBER: 430710433

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2025
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
Lead Testing Written Directives - a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Classroom Number 27 is currently closed and will re-open on 8/4/25. Staff are serving the Children(Room 22) filter water and refilling their individual water container. LPA received a copy of a Letter dated 6/12/25 prepared by Program Administrator stating that they will remove
8
9
10
11
12
13
14
Based on record review, the Lead Sampling Report in one(1)identified drinking fountain Room 27 Kitchen(R)had elevated lead above 5.5 ppb. This poses a potential risk to the health, safety, or personal rights of children in care.
8
9
10
11
12
13
14
the fountain and cap the associated plumbing by the end of June 13,2025. During today's visit, LPA observed the drinking fountain covered with plastic. Site Supervisor stated that she will submit a Plan by the POC date that will address if they will be removing the fountain as stated/written per Program Administrator's letter dated on 6/12/25.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Anna Morales
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3