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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710441
Report Date: 02/13/2020
Date Signed: 02/13/2020 03:20:35 PM

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:ROULEAU HEAD STARTFACILITY NUMBER:
430710441
ADMINISTRATOR:LINDA CHIUFACILITY TYPE:
850
ADDRESS:1875 MONROVIA DRIVETELEPHONE:
(408) 573-4006
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:105CENSUS: 101DATE:
02/13/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Cuc TranTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Dung Mac conducted an unannounced annual inspection to the facility today. LPA met with Cuc Tran, Site Director, and explained the nature of today's visit. The Facility is licensed in Rooms 1, 2,, 4, 5, and 6.

LPA toured the Facility both inside and outside for today's inspection at 10:10am. 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, Menus, and Activity Schedule.

LPA reviewed ten children's files and 15 staff files consisting of 1 site director, 4 teachers, and 10 associate teachers during today's inspection. All staff and children's files were complete. All staff have current CPR and First Aid certifications on file. Cuc understands 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 (field trips).

The program is operated by the Santa Clara County Office of Education and all criminal background checks for staff are handled by the Department of Education and thus do not come under the jurisdiction of Community Care Licensing Division.



LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed 15 preschool children with one teacher, one associate teacher, and one substitute-associate teacher in Room #1. LPA observed 17 preschool children with one teacher and two associate teachers in Room #2. Both classrooms shares a kitchen. LPA observed kitchen that is clean and sanitized. LPA observed 17 preschool children for AM class and 10 preschool children for PM class with one teacher, one associate teacher, and one substitute-associate teacher in Room #4 . LPA observed 13 preschool children (AM class) and 13 children (PM class) with one teacher and one associate teachers in Room #5 AM class. LPA observed 16 preschool children with one teacher, two associate teachers, and one substitue-associate teacher in Room #6.

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SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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 2
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: ROULEAU HEAD START
FACILITY NUMBER: 430710441
VISIT DATE: 02/13/2020
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Cuc understands the conditions, limitations, and capacity specifications of the Facility license. Cuc understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and safe for all children and staff. Water cooler is readily available for the children in each room and outdoor playground area via water dispensers/disposable cups.

LPA observed solid waste containers with tight-fitting lids in the facility. Each classroom has elctronic sign in/out. Staff and children's bathrooms are clean, sanitary, and operable. Cuc states that there are no weapons or firearms on the premises.

The food is brought by Revolution Foods on Monday-Friday. Staff prepare breakfast, snack, and lunch for Rooms 1, 2, & 6, breakfast and lunch for Rooms 4 & 5 for AM class, and lunch only for Rooms 4 &5 PM class. Cleaning supplies are inaccessible to the children and stored in high cabinets. Any poisons are stored in locked storage inaccessible to children. Medication is currently being administered by the Facility at this time. Incidental Medical Services (IMS) was discussed with Cuc.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed building overhang and canopy which provide shade for the day care children. LPA observed two locked sheds and no bodies of water.

LPA conducted an exit interview with the Josephine prior to the conclusion of today's visit.
No deficiencies were cited during visit.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FACILITY ENTRANCE, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
LIC809 (FAS) - (06/04)
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