434407983-10-7-2021-07-CC-EBEN-C7KVZC-20211007165227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407983
Report Date: 10/07/2021
Date Signed: 10/07/2021 04:52:57 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:	HOLY SPIRIT PRESCHOOL		FACILITY NUMBER:	434407983
ADMINISTRATOR:	DEBRA D'AMICO		FACILITY TYPE:	850
ADDRESS:	1198 REDMOND AVENUE		TELEPHONE:	(408) 268-0775
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	48	CENSUS: 6	DATE:	10/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Debra D'Amico		TIME COMPLETED:	01:15 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) Elizabeth met with Director, Debra D'Amico for an unannounced Required - 1 year inspection (KIT 2). LPA toured the Facility both indoor and outdoor areas during today's inspection. LPA notes that the Facility is licensed in Rooms PK1 and PK2. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Facility has waivers for bathroom and shared playground. Pre-School shares play ground with the Kindergarten at different times. A review of staff records on September 21, 2021 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 Evangeline 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 reviewed ten children's and 2 staff files during today's inspection Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff per Room with current CPR and First Aid certifications on file. Debra D'Amico 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 (field trips).

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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: HOLY SPIRIT PRESCHOOL	FACILITY NUMBER: 434407983
	VISIT DATE: 10/07/2021

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's inspection. Debra understands the conditions, limitations, and capacity specifications of the Facility license. Debra understands that children shall be visually supervised at all times. LPA observed two teachers with 3 preschool children in Room PK1, one teacher with three preschool children in Room PK2. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Debra states that the Facility has janitors that clean the Facility Monday through Friday in the evenings. Debra understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in each Room and in the outdoor playground area via water bottles/water. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Debra states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors.

Children bring home from lunch. Friday's pizza is delivered to school. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored inaccessible to children. Any medications at the Facility are stored in each individual Room. The center provides Incidental Medical Services (IMS).

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by shade tarp and building over hang. There is sufficient resilient materials (rubber surfacing) in the outdoor playground area. LPA did not observe any bodies of water.
LPA conducted an exit interview with Debra prior to the conclusion of today's inspection and advised her that no deficiencies issued during today's inspection.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS. This report will be emailed to Debra (debra.damico@dsj.org).

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

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