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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400031
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:48:18 PM

Document Has Been Signed on 03/06/2024 04:48 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:SANTA CLARA CHRISTIAN PRESCHOOLFACILITY NUMBER:
434400031
ADMINISTRATOR:RACHEL EATONFACILITY TYPE:
850
ADDRESS:3421 MONROE STREETTELEPHONE:
(408) 246-5423
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 75TOTAL ENROLLED CHILDREN: 53CENSUS: 39DATE:
03/06/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Stuart Nice and Rachel EatonTIME COMPLETED:
01:40 PM
NARRATIVE
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On 03/06/2024 at 9:25am, Licensing Program Analyst (LPA), Farida Raja, met with Principal, Stuart Nice, for an unannounced Required-3 Year inspection. Director, Rachel Eaton arrive at 9:45 am. The facility is licensed to serve children ages 2-5 years in four rooms. The facility has one waiver on file for electronic sign in/ out. LPA observed the required posted materials in each classroom including monthly menus, weekly lesson plan and daily activity schedule. Days and hours of operation are Monday through Friday, 7:00 am to 6:00 pm.

LPA and Director toured the indoor and outdoor areas of the facility during today's inspection and observed the following ratios:
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Room 12 (Brown Bears: 4- 5 years): 18 children and 2 teachers
Room 13 (Panda Bears: 3.5 - 4.5 years): 8 children and 2 teachers
Room 14 (Koala Bears: 3 - 4 years): 5 children and 1 teacher
Room 15 (Polar Bears: 2 - 3.5 years): 8 children and 2 teachers

Facility was in compliance with teacher to children ratio requirement. The classrooms, children's restrooms, staff restroom, kitchen and outdoor area were inspected. LPA observed children having snack or engaged in various activities under the visual supervision of teachers. Facility has central heating and wall mounted air conditioning unit for comfort of children. Director states that there are no weapons including firearms on the premises. There is a working telephone at the facility (408-246-5423). Disinfectants, cleaning products and medicines were stored inaccessible to the children in care. All cabinets used for storage were observed to be locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed appropriate changing tables in Room 15 have raised sides and vinyl changing pads that are at least 1 inch thick. Napping mats were appropriate. LPA observed solid waste containers with tight-fitting lids in each room and in the outdoor areas.

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Gladys Kuizon
Farida Raja
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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: SANTA CLARA CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434400031
VISIT DATE: 03/06/2024
NARRATIVE
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The children use the bathrooms that are located in one central area away from the classrooms. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom located in the office area.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in fire system. Log shows that the last Fire Drill was conducted on 02/29/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room via individual water bottles and refilled using the water faucet in each room. Drinking water is available outdoors through drinking water fountains. Water lead testing was completed for the facility on 3/25/2023 with one Action Level Exceedance value of 7.0 ppb in Faucet D- Sink Faucet in Room 15. LPA provided Director with the Water Lead Report from the California State Water Resources Control Board during today's inspection. Facility completed retesting on 6/10/2023 and provided LPA with a copy of the External Water Sampler Self-Certification Form (LIC9275), Sampling Checklist Form (LIC 9276), Facility Sketch (LIC999) labeled with locations of water outlets and Water Lead Retest report which shows no action level exceedance.

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.

Facility provides morning and afternoon snack. Children are provided snacks in disposable plates and cups. Children bring lunches from home and facility provides optional lunch through My Green Lunch as well. Kitchen used to store and prepare snacks was observed to clean. Monthly menu and children's allergy list was observed to be posted in the kitchen area. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards.

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SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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: SANTA CLARA CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434400031
VISIT DATE: 03/06/2024
NARRATIVE
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LPA observed play equipment was in good condition, age-appropriate, and has sufficient tan bark as resilient materials to absorb falls. Areas around and under high climbing equipment and slides were cushioned with resilient material. Shaded rest area is provided by one large canopy and trees. There were no bodies of water observed. LPA observed a covered sand box in the outdoor area.

Children's electronic sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed eight (8) children's files during today's inspection. Each child's file reviewed contained the required forms.

LPA reviewed five (5) staff files. All facility staff who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. All staff files reviewed contain the required transcripts/verification of experience. No staff member on site has a current CPR and First Aid certification on file. 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). LPA observed the required Mandated Reporter Training for all staff. Through file review and director interview, LPA observed staff (C1 and C4) do not have proof of immunization for measles.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director stated that facility does handle medications but currently has no children in care who require Incidental Medical Services. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Director stated that medications like EpiPen are stored in each class out of reach of children. Other medications are stored in the Resource Room which can be accessed though Room 13. Medication log was observed to be maintained whenever medication is administered to children. Director stated that medication that requires refrigeration is stored in the refrigerator used by staff. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided.

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SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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: SANTA CLARA CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434400031
VISIT DATE: 03/06/2024
NARRATIVE
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A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. 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/.

Facility does not provide transportation to children. 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

Two (2) Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Director. Exit interview conducted and report was reviewed with Director, Rachel Eaton.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/06/2024 04:48 PM - It Cannot Be Edited


Created By: Farida Raja On 03/06/2024 at 01:01 PM
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: SANTA CLARA CHRISTIAN PRESCHOOL

FACILITY NUMBER: 434400031

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 03/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above for two staff which poses a potential health, safety or personal rights risk to persons in care. Staff (C1 and C4) are missing immunizations for measles and staff, C1 is missing the Health Screening Report (LIC 503).
POC Due Date: 03/20/2024
Plan of Correction
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Director will submit the missing documents to LPA by plan of correction date of 03/20/2024.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited which poses a potential health, safety or personal rights risk to persons in care. No staff member on site has a current CPR and First Aid certification on file. Director was reminded 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.
POC Due Date: 03/20/2024
Plan of Correction
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Director will submit plan of correction to LPA by 03/20/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024


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