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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710593
Report Date: 09/22/2022
Date Signed: 10/05/2022 03:43:22 PM


Document Has Been Signed on 10/05/2022 03:43 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SJB - CHERRYWOOD EXTENDED DAY CAREFACILITY NUMBER:
430710593
ADMINISTRATOR:DONNA CLUBBFACILITY TYPE:
840
ADDRESS:2550 GREENGATE DRIVETELEPHONE:
4082599739
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:53CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH: Ofelia Saldivar TIME COMPLETED:
12:58 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Collins conducted an unannounced Annual inspection of the facility today. Upon arrival, LPA met with Program Director Ofelia Saldivar and explained the purpose of today's inspection. The Extended Care Program operates Monday through Friday from 7:00am to 6:00pm, serving children ages 5-12 years. No Children were present during this inspection.

The program is operating on a functioning school site, Cherrywood Elementary School, and is located in one of the portables. The portable is divided into 2 rooms. Room 1 is used for children who are currently in Kindergarten to Second Grade. Room 2 is for children who are in Grade 3 and above.

Facility's License, Notification of Parents’ Right Poster, Snack Menu, Child Car Seat Law, Activity Schedule and LIC613A Personal Rights were observed to be posted. LPA discussed with staff about the personal rights of children in care.
Staff files review included; Staff qualifications, Proof of immunization, current Pediatric CPR and First Aid Certification, Proof of TB Clearance, Proof of Immunization, Health Screening Report, Criminal Record Statement, Statement Acknowledging Requirement of report Child Abuse, Mandated Reporter and Employee rights.


The physical plant was inspected. LPA toured the building inside and out. The two classrooms, two restrooms, kitchen, storage areas, and office area were inspected. There were no bodies of water observed. Site Director stated that facility do not have weapons on the premises. Furniture and equipment were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Restrooms for the children’s use were observed to be in safe and sanitary operating conditions and provided individual privacy. Floors were clean and safe, and outdoor activity space were free of hazards. Indoor temperature measured at 76 Degrees F. Playground equipment was in good condition and areas around high climbing equipment have resilient material to absorb falls. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to children were stored inaccessible
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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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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: SJB - CHERRYWOOD EXTENDED DAY CARE
FACILITY NUMBER: 430710593
VISIT DATE: 09/22/2022
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LPA observed that drinking water was readily available to children indoor and out. Foods and beverages were kept protected against contamination and spoilage. Kitchen and food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

First aid kits were observed in each classroom and inspected. Fire extinguishers and smoke detectors meet State Fire Marshall standards. Carbon monoxide detector were observed in each classroom. Log shows that Fire drill was last conducted 08/29/22.
LPA also reviewed with Site Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Site Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

In the areas that were evaluated, no regulatory violations were observed at the time of the visit.

Exit interview was conducted, where this report was reviewed with Program Director
Ofelia .

.A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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