434400477-5-9-2019-07-CC-YHUG-BBZNBC-20190509101857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400477
Report Date: 05/09/2019
Date Signed: 05/09/2019 10:19:01 AM

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:	ALMADEN PRESCHOOL		FACILITY NUMBER:	434400477
ADMINISTRATOR:	STORIE, PATSY		FACILITY TYPE:	850
ADDRESS:	1295 DENTWOOD DRIVE, PS 1 & 2		TELEPHONE:	(408) 535-6677
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	47	CENSUS: 25	DATE:	05/09/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cesar Herrera		TIME COMPLETED:	10:30 AM

NARRATIVE

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Licensing Program Analyst (LPA), Oscar Huang, met with teacher Cesar Herrera for a case management inspection in response to an unusual incident that was reported by the facility on April 29, 2019. The incident occurred on April 22, 2019 involving a five-year-old child. LPA toured the facility, interviewed staffs, and reviewed the child file. Based on interviews with the staffs, LPA concluded that the child who left the line and went to the bathroom by herself and stayed unattended in the classroom while all other children of the classroom were playing outdoor with staffs.

Due to result of the investigation, the facility is cited with type "A" deficiency for for violating Care and Supervision, 101229(a)(1). No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1) on the attached LIC 809-D. A notice of site visit was issued and must be posted near the facility entrance along with the Type "A" deficiency and must remain posted for 30 consecutive days.

LPA discussed the reporting requirements of AB633 to Teacher Herrera and provided him with a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and he understands the requirements. Upon receipt, the facility shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months, and obtain the signatures from the parents and keep it in each child's file.

An immediately Civil penalty of $500 was assessed due to the zero tolerance.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

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: ALMADEN PRESCHOOL	FACILITY NUMBER: 434400477
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/10/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement was not met as evidenced by: On 4/22/19, C-1 was left in the classroom unsupervised.	1 2 3 4 5 6 7	Director to submit CCL plan of correction in written indicating methods and procedures implemented to ensure the facility stays in compliance with Tittle 22, Care and Supervision regulations, as well as to schedule a title 22 supervision training for all staffs. A copy of agenda including names and signatures of staff who attended, shall also be sent to CCL by the POC due date.
	8 9 10 11 12 13 14	This poses an immediate safety & health risk to children in care. Due to this zero-tolerance deficiency being cited today, immediately civil penalties in the amount of $500 are assessed.	8 9 10 11 12 13 14	AB633 Parent Notification is required. According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this Type A deficiency.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC809 (FAS) - (06/04)

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