434408045-8-8-2022-07-CC-PHEZ-CH4S6K-20220808133604

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408045
Report Date: 08/08/2022
Date Signed: 08/08/2022 01:36:13 PM

Document Has Been Signed on 08/08/2022 01:36 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:	PARK AVENUE PRESCHOOL		FACILITY NUMBER:	434408045
ADMINISTRATOR:	OPHELIA IMPERIAL		FACILITY TYPE:	850
ADDRESS:	1080 THE ALAMEDA		TELEPHONE:	(408) 294-4807
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	43	CENSUS: 12	DATE:	08/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Ophelia Imperial		TIME COMPLETED:	01:45 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) Pete Hernandez LPA met with Licensee, Ophelia Imperial for a Required 1 Year inspection and explained the nature of today's inspection. Head Teacher's CPR/1st Aid is current and expires 4/10/2024. There were 2 Teachers and 11 children observed. 10 children's files were reviewed. All required documents were present in the files. Ophelia Imperial plus one Teacher; 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 current. The last entry was done on 8/5/2022. 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 9/8/2022:

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

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: PARK AVENUE PRESCHOOL	FACILITY NUMBER: 434408045
	VISIT DATE: 08/08/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 9/08/2022:

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 being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see 809D. An exit interview was conducted. A copy of this report and appeals rights was discussed and left with the Licensee, Ophelia Imperial , 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 Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/08/2022 01:36 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: PARK AVENUE PRESCHOOL	FACILITY NUMBER: 434408045
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2022

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
1 2 3 4	Based on today’s inspection, Licensee and TeacherProvider do not have completed Mandated Reporter Training AB 1207. Licensee stated that she was unaware of this requirement. This poses a potential risk to the children.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	LPA provided the web address https://www.mandatedreporterca.com for Licensee to access the required training. BY POC DUE DATE 9/30/2022. Licensee and Assistant Provider will complete the training and send a copy of the Certificate of Completion to Licensing Office.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC809 (FAS) - (06/04)

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