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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407594
Report Date: 06/18/2019
Date Signed: 06/18/2019 11:49:33 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:GRACE PRESCHOOLFACILITY NUMBER:
434407594
ADMINISTRATOR:KRISTY CURRIEFACILITY TYPE:
850
ADDRESS:111 CHURCH STREETTELEPHONE:
(408) 354-7163
CITY:LOS GATOSSTATE: CAZIP CODE:
95030
CAPACITY:69CENSUS: 25DATE:
06/18/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kristy Currie TIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Unannounced Case Management - Deficiencies Inspection at the facility today. Upon arrival, LPA observed twenty five (25) preschool age children and at least seven (7) staff engaging in daily activities and met with Ms. Kristy Currie, Director. The facility currently operating under Summer Program Hours which are Monday through Thursday from 9:00am to 12:00pm. The purpose of the inspection is to cite deficiencies observed during record reviews conducted during this inspection and previous inspections.

LPA and the Director discussed updates to the Mandated Reporter Training Requirement per AB 1207 and the Effects of Lead Exposure for children and families.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days. A Deficiency has been cited today. Please refer to page 809-D for citation, description, and plan of correction. Appeal rights have been provided and discussed.

Exit interview conducted with Ms. Kristy Currie, Director.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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: GRACE PRESCHOOL
FACILITY NUMBER: 434407594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2019
Section Cited
CCR
101216.1(g)
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Teacher Qualifications and Duties

A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful
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To be completed by the end of the day by the POC due date, the Director has agreed to ensure all staff files are complete and up to date by conducting a comprehensive audit of all files. The Director has also agreed to submit
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completion of required course work, shall be maintained at the center.
This violation is evidenced by incomplete staff transcripts maintained on file at the faciltiy. This presents a potential risk to the health and safety of children in care.
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a written plan to Community Care Licensing outlining how the faciltiy plans to be maintain compliance with this requirement moving forward.
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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) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
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