<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408045
Report Date: 09/09/2021
Date Signed: 09/09/2021 01:03:59 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:PARK AVENUE PRESCHOOLFACILITY NUMBER:
434408045
ADMINISTRATOR:OPHELIA IMPERIALFACILITY TYPE:
850
ADDRESS:1080 THE ALAMEDATELEPHONE:
(408) 294-4807
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:43CENSUS: 21DATE:
09/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Ratinder CheemaTIME COMPLETED:
01:04 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) Pete Hernandez LPA met with Licensee, Ratinder Cheema for a Required 1 Year inspection and explained the nature of today's inspection. Licensee's CPR/1st Aid is current and expires 10/8/2021. Six children's files were reviewed. The teacher/adult-child ratio was in compliance. LPA reviewed the sign in/out sheets. Drinking water indoor is available at all times. Snack provided; current menu was observed. There is a kitchen at the facility for food preparation and is equipped with refrigerator, stove, dishwasher, microwave, and a sink with hot and cold running water. LPA observed trash cans with tight fitting covers for the disposal of solid waste. Children's bathrooms are sanitary and operable. There is a custodian for the facility that cleans the school one evening a week. Licensee states that there are no weapons on the premises. Facility has operating fire extinguishers, smoke alarms, carbon monoxide detectors with fire pull stations. Licensee provided a copy of the children's roster to the LPA. Fire Drill was last done on March 12/ 2021.
The playground is surrounded with appropriate fencing. Shade is provided by covering at two locations and building overhang. LPA observed resilient material under the climbing structures. LPA did not observe any bodies of water. Drinking water outdoor is via drinking fountain.
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 Prudence. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 9/9/2021:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PARK AVENUE PRESCHOOL
FACILITY NUMBER: 434408045
VISIT DATE: 09/09/2021
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
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 9/9/2021:

Incidental Medical Services (IMS) policy was discussed. No medications currently provided to children under IMS. 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

All staff are associated to the licensed facility. LPA reminded the Licensee of 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. A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

TYPE A language: Should there ever be an 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 NOT 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. A copy of this report was discussed and left with the Licensee, Ratinder Cheema , 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: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2