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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403520
Report Date: 02/26/2020
Date Signed: 02/26/2020 01:10:07 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:MY PRESCHOOLFACILITY NUMBER:
434403520
ADMINISTRATOR:HADIAN, SOHAYLAFACILITY TYPE:
850
ADDRESS:1472 SARATOGA AVENUETELEPHONE:
(408) 376-0385
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:50CENSUS: 46DATE:
02/26/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sohayla "Sally" HadianTIME COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Deficiencies. Upon arrival, LPA met with Ms. Mireja Viches. Director Sohalya "Sally" Hardian arrived at 9:37AM. LPA explained the reason for the inspection.

At 8:52AM, LPA that there were 32 children and 2 staff. Facility was not in compliance with the teacher child ratio. At 9:03AM, LPA observed that there were three staff who clocked in. LPA also reviewed sign-in/out sheet at 9:28AM and observed that there were 31 children signed in by 8:50AM.

LPA discussed with Director Sally about the teacher child ratio. Director Sally acknowledged that facility was out of ratio from 8:51AM to 9:03AM. LPA discussed with Director Sally her plan to ensure that facility is in compliance with teacher child ratio. Director stated that she will have one of her staff start at 8:30AM. She also discussed with her staff during inspection about notifying her when they are about to go over ratio and to call for support.

As a result of this inspection, a Type A deficiency has been cited. An exit interview was conducted where this report, citation, plan of correction, and appeal rights were discussed and provided to Director Sally Hadian.

LPA also discussed about AB 633 requirement to provided a copy of 809 report dated 02/26/2020 and obtain a signed copy LIC 9224 for each child in care within one business days. LPA also discussed with Director that a copy of this report and a signed copy of LIC 9224 is required for any newly enrolled children within the 12 month period. LPA provided a copy of LIC 9224 and fact sheet to Director.

A Notice of Site Visit was issued and must be posted for 30 consecutive days; along with a copy of 809 report.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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: MY PRESCHOOL
FACILITY NUMBER: 434403520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/27/2020
Section Cited

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Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...
This requirement is not met as met as evident by:
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Based on observation and record review, Licensee did not ensure facility was in compliance with teacher-child ratio. Faciltiy had 32 children and 2 staff. This poses a immediate risk to the health and safety to the children in care.
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Personnel Report to Licensing office.
AB633 Parent Notification is required.This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2020
LIC809 (FAS) - (06/04)
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