430710441-1-25-2024-07-CC-FRAA-CZTNCE-20240125092036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710441
Report Date: 01/24/2024
Date Signed: 01/25/2024 09:20:43 AM

Document Has Been Signed on 01/25/2024 09:20 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:	ROULEAU HEAD START		FACILITY NUMBER:	430710441
ADMINISTRATOR:	CUC TRAN		FACILITY TYPE:	850
ADDRESS:	1875 MONROVIA DRIVE		TELEPHONE:	(408) 573-4006
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	105	CENSUS: 42	DATE:	01/24/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Cuc Tran		TIME COMPLETED:	03:50 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	On 01/24/2024 at 11am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Cuc Tran , for an unannounced Required-3 Year inspection. The facility is licensed to serve children ages 2.5 years to entry into kindergarten in five rooms (1,2,4,5,6) and the multipurpose room. Rooms 1,2 and 6 were in use during today's inspection. Director stated that rooms 4 and 5 are not currently being used due to staff shortages. LPA observed the rooms to be empty. Director stated that the multipurpose room is used on days when children cannot go outdoors and for teacher training purposes. The facility has one waiver on file for electronic sign in/ out. LPA observed the required posted materials including menus, lesson plans and daily activity schedule in each classroom. Days and hours of operation are Monday through Friday, 8:00 am to 5:00 pm. LPA observed: Room 1: 3 teachers and 14 children. Room 2: 3 teachers and 12 children. Room 6: 3 teachers and 16 children. Facility was in compliance with teacher to children ratio requirement. LPA and director toured the indoor and outdoor areas of the facility. The classrooms, children's restrooms, staff restrooms and kitchen were inspected. Staff were interacting with children while they were having lunch during today's inspection. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408) 573-4717. Disinfectants and cleaning products were observed to be stored in high cabinets in the bathroom area. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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: ROULEAU HEAD START	FACILITY NUMBER: 430710441
	VISIT DATE: 01/24/2024

NARRATIVE

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Floors were clean and free from tripping hazards. LPA observed rug edges tapped to the ground to avoid children tripping over them. Napping mats were appropriate and stored with separators in between to avoid them touching. LPA observed solid waste containers with tight-fitting lids in the rooms, bathrooms and in the kitchen area. Restrooms and sinks for children and staff bathrooms were observed to be safe, sanitary, and in working condition. Director stated that classrooms are divided into zones and teachers clean their given areas.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. LPA observed Emergency Disaster Plans and first aid bags near the exit in each classroom. Each classroom conducts and logs separate fire drills and LPA observed the fire drills were conducted within the six-month requirement for facilities.

Drinking water is readily available for children in each room through a water dispenser and plastic cups and in the outdoor playground area through water coolers and disposable cups. Water lead testing was completed for the facility on 11/14/2022 and no Action Level Exceedances were reported.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA obtained a copy of the water lead test report along with the LIC 9275, LIC 9276 and facility sketch indicating water outlets tested. The drinking water fountains in the outdoor area were not tested. Director stated that children do not drink water from those and LPA observed the water fountains were covered and inaccessible to children. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Food storage and preparation areas were observed to be sanitary. LPA observed foods and beverages were stored safely to prevent contamination and spoilage. Food is provided through Kidango and is stored, prepared, and served in a safe and healthful manner to the children. Facility provides breakfast and lunch to the children and the does not allow food from home. LPA observed the monthly menu and food restrictions/allergy list on the refrigerator.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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: ROULEAU HEAD START	FACILITY NUMBER: 430710441
	VISIT DATE: 01/24/2024

NARRATIVE

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Two outdoor playgrounds and play equipment were inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has rubber flooring under play structures to absorb falls. Shaded rest area is provided by canopy and trees. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed six (6) children's files during today's inspection. Each child's file reviewed contained the required forms.

LPA reviewed six (6) staff files. All staff files reviewed contain the required transcripts/verification of experience. All staff had valid pediatric CPR/First Aid certification. Director 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). All staff have the required immunization's against pertussis, measles and influenza (or statement declining the influenza vaccine). LPA observed the required Mandated Reporter Training on file for all staff.

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.

Director stated that facility does handle medications and currently has children in care who require Incidental Medical Services (IMS). LPA observed medications stored inaccessible to children with parental consent forms. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Isolation of sick child was discussed, and Director stated that sick children will be isolated in room 4 or 5 which has a separate bathroom and a teacher will be present with them. 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/.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ROULEAU HEAD START	FACILITY NUMBER: 430710441
	VISIT DATE: 01/24/2024

NARRATIVE

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LPA obtained a copy of the updated Emergency Disaster Plan (LIC 610) and Personnel Report (LIC 500) during today's inspection.

Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Exit interview conducted and report was reviewed with the Director, Cuc Tran.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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