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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408827
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:58:46 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:MACC PRESCHOOL EASTUS DRIVEFACILITY NUMBER:
434408827
ADMINISTRATOR:LAKSHMI SUBRAMANIANFACILITY TYPE:
850
ADDRESS:4660 EASTUS DRIVETELEPHONE:
(408) 446-4166
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:48CENSUS: 16DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Lakshmi SubamanianTIME COMPLETED:
02:00 PM
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On 10/28/2021 Licensing Program Analysts (LPA) Pete Hernandez conducted an unannounced Required 1 Year inspection of MACC Preschool Eastus Drive today. LPA met with Director Lakshmi Subramanian and explained the purpose of today's visit. Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, Activity Schedules, and Menus were observed to be posted. Facility's operating days and hours are Monday to Friday 8:00 AM to 3:30 PM. Sixteen preschool children were present during this inspection.

The physical plant was inspected. LPAs toured the building with the Director.
Indoor space: The two classrooms, and adjoining children restrooms area were inspected. All cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazards. Foods and beverages were stored safely. Food storage area was clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a 2A10BC Fire extinguisher, Smoke and Carbon Monoxide Detectors, fire pull stations. Log shows that the last Fire Drill was conducted on 9/29/2021 and are conducted monthly.

10 children's files were reviewed during today's inspection. All child files contained Admission Agreements, immunization's, Physician's and Parent's Health Report.

4 staff files were reviewed during today's inspection. The records reviewed include but not limited education credit and Mandated Reporter Training.Staff files contained appropriate educational units.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: MACC PRESCHOOL EASTUS DRIVE
FACILITY NUMBER: 434408827
VISIT DATE: 10/28/2021
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LPA reminded Director that Mandated Reporter Training requires renewal every 2 years. All of the staff have current mandated reporter certificates. The Director has a current CPR/1st aid card that expires on 1/9/2023. Director understands that at least one staff needs to have a current CPR / 1st aid certificates during business hours. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection.

Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Outdoor Space: Outdoor playground was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is available to children by water bottles during indoor and outdoor activities.

File Review: Currently no more than 48 children enrolled on any given day. Children sign in and out procedures and logs were reviewed. Children's Roster was reviewed, and a copy obtained.

Director stated that facility does handle medications but currently does not have any child in care who requires Incidental Medical Services. Facility has an approved IMS Plan on file with San Jose Regional Office. LPAs reviewed storage of medication and equipment / supplies. Isolation of sick children was discussed. Director states that she separates a sick child; usually in her office. A sick child will use one of the private stalls in the children's bathrooms which is cordoned off for the time and later sanitized and cleaned. Child is always under visual supervision while being cared for.

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.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: MACC PRESCHOOL EASTUS DRIVE
FACILITY NUMBER: 434408827
VISIT DATE: 10/28/2021
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LPAs reminded Director 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. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

TYPE A language: Should there ever be issuance of Type A citations today, 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 with the Licensee. A copy of this report was discussed and left with the Licensee, Lakshmi Subramanian, 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: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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