434407962-5-9-2025-07-CC-JBER-DGHQQR-20250509122248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407962
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:22:56 PM

Document Has Been Signed on 05/09/2025 12:22 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LOS GATOS ACADEMY PRESCHOOL		FACILITY NUMBER:	434407962
ADMINISTRATOR/ DIRECTOR:	JENNIFER SMOYLANITSKY		FACILITY TYPE:	850
ADDRESS:	16837 PLACER OAKS ROAD		TELEPHONE:	(408) 242-9342
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY: 34	TOTAL ENROLLED CHILDREN: 34	CENSUS: 13	DATE:	05/09/2025
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Jennifer Smolyanitsky		TIME VISIT/ INSPECTION COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Case Management - Plan of Corrections inspection. The purpose of today's visit is to review the deficiencies cited on 04/24/2025. Upon arrival, LPA was greeted by the Director, Jennifer Smolyanitsky and provided access to the facility. There were 2 Teachers, 1 Aide and 1 Director present along with 13 children when LPA arrived. This is compliant with ratio and capacity requirements for the facility. LPA was granted access to the staff files. 4 staff files: 1 - director, 2 - teachers and 1 - aide were reviewed for the following records: Transcripts/Verification of Experience, Health Screening Report (LIC503), Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, Tuberculosis (TB) Clearance, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). There is at least one staff member present with current CPR/First-Aid that expires 08/2025. All staff's Mandated Reporter certificates were expired. LPA reminded the Director that the Mandated Reporter Training must be renewed by all staff every 2 years. Director stated all staff would complete Mandated Reporter this weekend. Director will complete CPR training 05/12/2025 as her certification is expired. Director stated the Aide that has CPR is on staff to open and close during the preschool hours. Director's teacher's permit was expired and she did not have proof of her transcripts on file. LPA reviewed the Fire/Disaster Drill log and verified the last drill was conducted 03/11/2025 at 11:00 AM which is compliant with the 6 month requirement. Continued on Page 2

Gladys Kuizon	TELEPHONE: (510) 566-5850
Jennifer Beehler	TELEPHONE: (408) 324-2148
	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOS GATOS ACADEMY PRESCHOOL	FACILITY NUMBER: 434407962
	VISIT DATE: 05/09/2025

NARRATIVE

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During LPA's tour of the interior of the facility, LPA observed water bottles in the fridge for drinking and a case of additional water. Paper products such as cups and bowls were used to disperse snacks. Director stated they serve dry fruit, oranges or bananas. Nothing needs to be cleaned or prepped with water prior to serving. LPA collected a letter of attestation regarding the water faculties for the facility building. LPA will review with the Department to determine if anything additional is required from the facility regarding the written directives from PIN 21-21.1-CCP.

LPA toured exterior of the facility and observed the hazardous chemicals in the garage had been placed in plastic tubs and stored on the top shelf of the garage, inaccessible from children in care.
LPA observed the outdoor play activity space and confirmed the panels on the upper deck of the large play structure were secured and safe for children in care.

LPA discussed supervision with teachers in the outdoor space. Director provided a written plan with a map showing where teachers must stand and how they position their bodies when there is only two teachers outside and children need to use the restroom. Director also stated the secondary playground which is behind the garage will be closed off if there are only two teachers due to lack of visual supervision without three teachers present.

LPA discussed the changes to the licensees corporation, which dissolved on 10/01/2020. Director stated that she created a new corporation. LPA collected an updated Administrative Organization document with the correct information for the current corporation that owns the preschool. Director stated the owner of the property has given the facility a notice of eviction effective 05/30/2025. LPA observed toys and other items packed, items removed from shelves and walls. Director stated she would not continue with the day care at that time and arrangements had been discussed with parents and current students along with all staff.

Due to today's inspection, a civil penalty has been assessed due to failure to correct deficiencies previously cited on 04/24/2025, more details provided on the attached LIC421FC.

Exit interview conducted with the Director, Jennifer Smolyanitsky. Report reviewed and provided along with appeal rights.

NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

LIC809 (FAS) - (06/04)

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