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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403563
Report Date: 09/21/2022
Date Signed: 09/21/2022 12:14:08 PM


Document Has Been Signed on 09/21/2022 12:14 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:SACRED HEART PRE-SCHOOLFACILITY NUMBER:
434403563
ADMINISTRATOR:CAMARENA, JUDYFACILITY TYPE:
850
ADDRESS:13718 SARATOGA AVENUETELEPHONE:
(408) 867-9241
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:32CENSUS: 11DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Judy CamarenaTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Pete Hernandez conducted a required 1 year inspection LPA met with Site Director, Judy Camarena, and explained the nature of today's inspection. LPA notes that there is one classroom in the preschool program. LPA toured the indoor and outdoor areas of the facility. LPA observed all the required posted materials.

There is an active waiver: to allow licensure although outdoor space is shared with another program.
LPA observed 11 preschool children in room and 2 fully qualified Teachers in the Preschool Room.
Site Director has current CPR and First Aid certification with an expiration date of 6/16/2023. Site 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. LPA observed that the teacher/child ratio was in compliance during today's inspection. Site Director understands that the children shall be visually supervised at all times and never left unattended. LPA reviewed the sign in and sign out sheets and children's roster. Two children had not been signed in on 9/21/22. LPA reviewed ten random children's files and two staff files. All required documentation was in their respective files.

Staff and children's bathrooms are sanitary and operable. Drinking water is readily available for the children indoor and outdoor via drinking fountain. There is a trash can in the room with tight fitting cover for the disposal of solid waste. The center provides snacks to the children. LPA observed adequate food for snacks. Cleaning supplies are stored in the upper cabinet in the kitchen area in the classroom inaccessible to the children. LPA observed hard wired smoke alarms, fire pull stations, and functioning carbon monoxide detectors at the facility. Site Director states that there are no weapons or firearms on the premises.

The playground area utilized by children is surrounded by appropriate fencing. LPA observed rubberized ground cover as resilient material under the climbing structures. LPA did not observe any bodies of water.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/21/22):
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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: SACRED HEART PRE-SCHOOL
FACILITY NUMBER: 434403563
VISIT DATE: 09/21/2022
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 04/11/2019):
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

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Site Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.



LPA discussed and facility is in compliance with Senate Bill 792 (required immunization for employees or volunteers). LPA also discussed Assembly Bill 1207 (mandated reporter training for child care workers) to Site Director.

Licensee and Teacher do not have current Mandated Reporter Certificates. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Website for resource information: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SACRED HEART PRE-SCHOOL
FACILITY NUMBER: 434403563
VISIT DATE: 09/21/2022
NARRATIVE
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Licensee maintains a current fire drill log and completes fire drill on a monthly basis. The most recent entry was 8/25/22.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Applicant. A copy of this report and appeals rights were discussed and left with the Applicant, Judy Camarena , whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/21/2022 12:14 PM - It Cannot Be Edited

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: SACRED HEART PRE-SCHOOL
FACILITY NUMBER: 434403563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Per LPA's observation, this requirement is not met as evidenced by: Based on today’s inspection, Licensee's Director and Teacher do not have completed Mandated Reporter Training AB 1207 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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LPA provided the web address https://www.mandatedreporterca.com for Licensee to access the required training. BY POC DUE DATE,10/31/2022, (S1) Licensee's Director and (S2) Teacher will complete the training and send a copy of the Certificate of Completion to Licensing Office.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation and record review, the licensee did not comply with the section cited above in 2 out of 11 preschool children on 9/21/022 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2022
Plan of Correction
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BY POC DUE DATE, Director will send to Licensing Office a plan of action on how facility will ensure that parents are signing their children in and out.

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 KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4