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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710485
Report Date: 02/04/2020
Date Signed: 02/04/2020 04:55:41 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:EDENVALE HEAD STARTFACILITY NUMBER:
430710485
ADMINISTRATOR:LE, THUY KIM/HUYNH ALINAFACILITY TYPE:
850
ADDRESS:5319 CARRYBACK AVENUETELEPHONE:
(408) 363-1823
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:57CENSUS: 34DATE:
02/04/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Josephine DalitTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Dung Mac and Mel Matos, conducted an unannounced annual inspection to the facility today. LPAs met with Josephine Dalit, Interim Site Director, and explained the nature of today's visit. The Facility is licensed in Rooms 1, 2, & 3. Josephine states that the Facility is currently not using Room 3 but wishes to keep it on the license.

LPAs toured the Facility both inside and outside for today's inspection. LPAs 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.

LPAs reviewed ten children's files and six staff files consisting of 1 site director, 2 teachers, and 3 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. Josephine 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.



LPAs observed that the teacher/child ratio was in compliance during today's visit. LPAs observed 17 preschool children with one teacher and one associate teacher in Room #1. LPAs observed 17 preschool children with one teacher and two associate teachers in Room #2. Both classrooms shares a kitchen. LPAs observed kitchen that is clean and sanitized.

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

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: EDENVALE HEAD START
FACILITY NUMBER: 430710485
VISIT DATE: 02/04/2020
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Josephine understands the conditions, limitations, and capacity specifications of the Facility license. Josephine understands that children shall be visually supervised at all times. LPAs 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.

LPAs observed solid waste containers with tight-fitting lids in the facility. Staff and children's bathrooms are clean, sanitary, and operable. Josephine states that there are no weapons or firearms on the premises.

The facility provides breakfast, lunch, and snacks. 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 Josephine.

LPAs 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. Children currently play in the playground in the back as the playground in front is being repaired at this time. LPAs observed that the outdoor equipment is age appropriate and in good condition. LPAs observed building overhang and trees which provide shade for the day care children. Resilient materials: Play N Pour rubber surfacing. LPAs observed two locked sheds and no bodies of water.

LPAs 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: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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