434408827-4-18-2024-07-CC-SYIP-D4FQ38-20240418114819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408827
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:48:28 AM

Document Has Been Signed on 04/18/2024 11:48 AM - It Cannot Be Edited

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 DRIVE		FACILITY NUMBER:	434408827
ADMINISTRATOR:	LAKSHMI SUBRAMANIAN		FACILITY TYPE:	850
ADDRESS:	4660 EASTUS DRIVE		TELEPHONE:	(408) 446-4166
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	48	CENSUS: 14	DATE:	04/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Lakshmi Subramanian		TIME COMPLETED:	11:55 AM

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) Samantha Yip conducted an unannounced Annual/Random inspection. LPA met with Director Lakshmi Subramanian and explained the reason for the inspection. Present during today's inspection were 14 children and at least three staff. Facility was within ratio during today's inspection. There is a board to post required postings, such as license, notification of parent's right, and car seat law. The hours of operation are Monday through Friday 8:00AM to 4PM. The center uses an electronic sign in/out. LPA reviewed electronic sign in/out, which has parent's full legal signature. LPA toured the inside and outside of the center with Director. Disinfectant and cleaning supplies were observed to inaccessible to children. LPA observed that there were box cutter in the back cabinet in the kitchen in Room K1. There are toys and equipment for children. Floors were free of tripping hazard. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 04/01/2024. Director stated that there are no weapons, such as firearms, stored on the premise. The outside area is fenced. Areas around play structure have resilient material. The resilient material, tan bark, was low; however, there is a rubber mulch below to absorb fall. LPA discussed with Director about refilling tan bark and that any water that collects needs to be dumped out. There were no bodies of water observed during today's inspection. Shaded rest area is provided through tree and building overhang. -------------------continues on 809 dated 04/18/2024 page 2------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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 5

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: 04/18/2024

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 809 dated 04/18/2024 page 1--------------------

Facility only provides afternoon snack. Menu is posted on their app. Drinking water is provided through Brita filter and individual water bottles.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

A copy of the facility roster was obtained. Five (5) children files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and parent's rights. LPA discussed with Director to ensure forms are filled out completely.

Three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter training. All staff have a valid CPR/1st Aid, which expires on 12/2024.

------------------continues on 809 dated 04/18/2024 page 3----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 04/18/2024

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 809 dated 04/18/2024 page 2-----------------

All staff present have cleared criminal record and child abuse index. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA also discussed with director about ensuring that staff are positioning where they can visually supervise children when in the restroom. LPA observed that a staff was at the doorway of the restroom; however was positioned where they cannot see the chid in the restroom. Staff was checking on the child and moved where they can visually supervise the child in the restroom.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Director Lakshmi Subramanian. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5