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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410620
Report Date: 07/31/2024
Date Signed: 07/31/2024 04:53:46 PM

Document Has Been Signed on 07/31/2024 04:53 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LITTLE TREE PLAYSCHOOL, THEFACILITY NUMBER:
434410620
ADMINISTRATOR/
DIRECTOR:		WRIGHT, RACHELEFACILITY TYPE:
850
ADDRESS:7275 SANTA TERESA BLVD.TELEPHONE:
(408) 972-9200
CITY:SAN JOSESTATE: CAZIP CODE:
95139
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 15DATE:
07/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:14 PM
MET WITH:Ramona LewandowskiTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Samantha Yip and Jennifer Beehler conducted an unannounced Annual Random inspection. LPA met with Director Ramona Lewandowski and explained the reason for the inspection. The purpose of this inspection is the center is requested to remove the toddler option from their license and will only be using Sanctuary Preschool Classroom. The overall capacity will remain the same. A fire clearance was granted on 07/15/2024. Facility has a waiver to use electronic sign in/out. Director was advised that the granted waiver for the toddler and preschool to share the outdoor space will be voided once the toddler option is removed from the license. Director also understands that she needs to get written permission from parents for children enrolled the toddler option to have them move to the preschool program.

There is an area to post required postings, such as license, notification of parent's rights, and personal rights. The hours of operation are Monday through Friday 7AM to 5PM.

Indoor measurements were conducted by LPA Monico on 05/19/2021:
PRESCHOOL ROOM: 37.500 x 40.833 = 1531.237 minus 26.504 (encumbered space) = 1,504.733
TOTAL PRESCHOOL INDOOR SPACE: 1,504.733 sq. ft. divided by 35 = 42 children

Outdoor measurements were taken by LPA Walker on 02/22/09:
PRESCHOOL PLAYGROUND
92.498 X 50 = 4624.747 - 28.668 = 4596.232 SQ FT.
TOTAL OUTDOOR SPACE: 4596.232 sq. ft. divided by 75 = 61 children

---------------------continues on 809 dated 07/31/2024 page 1----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 07/31/2024
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----------------continuation of 809 dated 07/31/2024 page 1--------------------

There are at least 30 chairs, six (6) tables, 26 mats, 19 cots, two toilets and two sinks. Sinks does have hot and cold running water. There are toys for the children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Director stated that there are no weapons, such as a firearms, stored on the premise.

The outside area is fenced. Shaded rest area is provided through canopies. Areas around play structure has resilient material. LPA observed that the tan bark is starting to get low below the slide. Director stated that she will submit proof of purchase and proof that additional tan bark is installed. LPA also discussed with Director to ensure that the tarp land on the ground is not exposed, which could cause a tripping hazard. There were no bodies of water observed during today's inspection.

The center does provide meals and snacks to children. Center will stop providing meals to children the end of this week. Kitchen has hot and cold running water. Menu was observed to be posted. Drinking water is provided through pitcher and 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/.

---------------------continues on 809 dated 07/31/2024 page 3--------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 07/31/2024
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A copy of the facility roster was obtained. Seven (7) children's files were reviewed. The records reviewed included but not limited to admission agreement and immunization records.

Four staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated Reporter, and Health Screening. LPA observed that S-1 and S-2 did not have Health Screening, and TB, on file. LPA discussed with Director that online CPR/1st Aid is not accepted.

All staff present during today's inspection have cleared criminal record clearance, child abuse index, or exemption. 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.

At 3:01PM, LPA observed that S-3 walked from the preschool room to the fellowship room, which is adjacent to the preschool room. S-1 was left alone with the children. S-1 does not have completion of any courses.

Center will submit the following:
- proof of purchase tan bark
- new prescription box for C-1

As a result of this inspection, Type A and Type B citations were issued. Exit interview conducted and report was reviewed with Director Ramona Lewandowski. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Director Ramona Lewandowski that this report dated 07/31/2024 documents one Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Licensee to provide a copy of this licensing report dated 07/25/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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Document Has Been Signed on 07/31/2024 04:53 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/31/2024 at 04:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.3(a)
Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. At 3:01PM, S-3 walked into the fellowship room; leaving S-1, who is aide, with 12 children. The door to the room was left open between the rooms
POC Due Date: 08/01/2024
Plan of Correction
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By POC 08/01/2024, center will submit written plan on how they will ensure that aides are not left alone with children except for nap time or to bring children to the restroom.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


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Document Has Been Signed on 07/31/2024 04:53 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/31/2024 at 04:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. S-1 and S-2 does not have health screening and TB test on file.
POC Due Date: 08/07/2024
Plan of Correction
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By POC 08/07/2024, center will submit proof of appointment for S-1 and S-2 to complete health screening and TB. Center will submit proof once it is completed.
Type B
Section Cited
CCR
101215.1(b)
(b) All child care centers shall have a director.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Director is short of 7 months of teaching experience to qualify her as director.
POC Due Date: 08/07/2024
Plan of Correction
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By POC 08/07/2024, center will submit either proof of additional teaching experience or a fully qualified director.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


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