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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411603
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:52:28 AM

Document Has Been Signed on 11/06/2025 11:52 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HOLY FAMILY SCHOOL PRESCHOOLFACILITY NUMBER:
434411603
ADMINISTRATOR/
DIRECTOR:		NATASHA LAZARFACILITY TYPE:
850
ADDRESS:4701 JOSEPH SPECIALE DRIVETELEPHONE:
(408) 978-1355
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 36TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
11/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:27 AM
MET WITH:Natasha LazarTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 11/06/2025, Licensing Program Analyst (LPA) Syeda Bahar met with Director, Natasha Lazar for an unannounced annual/random inspection in the preschool program. The facility is licensed to serve children ages 3 to 5 years old. LPA observed all the required forms are posted on the entry to the facility. Days and hours of operation are Monday through Friday, 8:15 AM to 4:30 PM. Later Meredith Somavia, the Principal of the ‘Holy Family School’ joined the inspection.

LPA toured the indoor and outdoor areas of the facility with the Director and Principal. LPA observed that the teacher-child ratio was in compliance. Fire drill was conducted on 10/17/2025. The facility has current children's roster. LPA observed the classroom floor and surface are clean. The facility has a working telephone, required size fire extinguisher and working smoke and carbon monoxide detectors. LPA observed fully stocked first-aid kits available in the classroom. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. The director stated that the isolation area for sick children is the director’s office room.

The outdoor play area is fully fenced. LPA observed there are two trees on the playground. The roots of the trees are growing out of the grass and visible on the grass surface. The tree roots are tripping hazard for the children in care during outdoor play time. LPA observed there is ample shade available. There are age-appropriate outdoor toys and materials for children. The play structure is securely installed into the ground. The ground surrounding the play structure is sufficiently padded and in good condition for safety. There are no pools or other bodies of water on premises. Drinking water is readily available for the children outdoors via water fountain and individual water bottles.
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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HOLY FAMILY SCHOOL PRESCHOOL
FACILITY NUMBER: 434411603
VISIT DATE: 11/06/2025
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LPA observed sufficient napping equipment are available for the children. Director stated that children bring their own napping equipment from home, and they are cleaned every week. Director stated that children bring food from home. LPA observed all the children’s food boxes and water bottles are labeled with their name. Director stated that the center also provides packaged food during lunch to the children. The school provided lunch is delivered by ‘My Green Lunch.’ Director stated all center provided foods are stored in the main school campus and it is brought to the class during lunch time. All center provided food items are properly labeled and stored separately from cleaning supplies. LPA observed that the kitchen food preparation area in the classroom is clean, adequately equipped, and free from hazardous materials. Food and snacks menus are posted and were reviewed. LPA observed trash cans with tight fitting covers for the disposable of solid waste. The director stated that there are no weapons or firearms on the premises.

LPA reviewed the facility roster and personnel report, and copies were obtained. LPA reviewed five (5) random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Parent Right's Receipt, Physician's Report with tuberculosis test, Child's Preadmission Health History, Immunization Record, and Personal Rights. LPA reviewed two (2) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. Every classroom has a fully qualified teacher. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. The Director’s CPR/First-Aid Certificate is current, completed in 8/22/2025, valid till 8/22/2027. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate is current, completed on 8/27/2024, expires on 8/27/2026.

The Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Facility roster and personnel report must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HOLY FAMILY SCHOOL PRESCHOOL
FACILITY NUMBER: 434411603
VISIT DATE: 11/06/2025
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Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Director 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.

Water lead testing was completed for the facility on 12/06/2023 and no Action Level Exceedances were reported. 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 referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HOLY FAMILY SCHOOL PRESCHOOL
FACILITY NUMBER: 434411603
VISIT DATE: 11/06/2025
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important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Per the Title 22, California Code of Regulations, the childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The outdoor play area must be free of hazards for the children in care. During today’s inspection, LPA observed two holes on the right-side of the green fence. LPA also observed there are two trees on the playground. The roots of the trees are growing out and visible on the grass surface. These tree roots are tripping hazard for the children in care during outdoor play time.



As a result, one ‘Type B’ deficiency was issued on attached page 809-D.

Section cited: Outdoor activity space - CCR 101238.2(d)(2):
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

Exit interview was conducted, report was reviewed with Director, Natasha Lazar.

Appeal rights were provided.

A Notice of Site Visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2025 11:52 AM - It Cannot Be Edited


Created By: Syeda Bahar On 11/06/2025 at 11:20 AM
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: HOLY FAMILY SCHOOL PRESCHOOL
FACILITY NUMBER: 434411603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2025
Plan of Correction
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By the Plan of Correction (POC) due date, 12/08/2025, the Director will ensure the outdoor's right side green fence holes are reparired and the playground's grass surface is free of tripping hazards. The Director will submit pictures of reparired outdoor playground fence and the grass surface, as proof to the department.
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.
Susy Cervantes
NAME OF LICENSING PROGRAM MANAGER:
Syeda Bahar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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