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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412730
Report Date: 08/21/2019
Date Signed: 08/21/2019 05:53:54 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:LEGACY CHRISTIAN PRESCHOOLFACILITY NUMBER:
434412730
ADMINISTRATOR:DEBBIE HUDSONFACILITY TYPE:
850
ADDRESS:420 ALLEGAN CIRCLETELEPHONE:
(408) 225-5976
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:100CENSUS: 64DATE:
08/21/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Flynn, WendyTIME COMPLETED:
06:05 PM
NARRATIVE
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On 08/21/2019 at 8:35 AM Licensing Program Manager (LPM) Segura, Mary and Licensing Program Analyst (LPA) Almaraz, Araceli, Licensing Staff, began conducting an annual random inspection. Licensing Staff met with the Center Director, Flynn, Wendy and explained the nature of today's inspection. There were 64 children present. The hours of operation of the Pre School are 7 AM to 6 PM, Monday through Friday.

Licensing Staff inspected the indoor areas of the facility. Licensing Staff inspected Room A and observed that there were ten children present and one Teacher Cowart, Amanda. Licensing Staff observed one adult staff and ten children. Licensing Staff observed there was a working smoke/carbon monoxide detector, 3A40BC fire extinguisher in the alcove between Room A and B. The fire extinguisher was last serviced 12/18/2018. All cleaning products and similar items are stored inaccessible to children in Room A. Licensing Staff observed all materials in this room are safety compliant. The sign in/sign out sheets were complete. There is a bathroom in the alcove between Room A and Room B. The bathroom has three toilets and two sinks.

Licensing Staff inspected Room B and observed that there were eleven children present and one Teacher Rios, Tanya. Licensing Staff observed there was one adult and eleven children. Licensing Staff observed there was a working smoke/carbon monoxide detector and cleaning products/similar items are stored inaccessible to children in Room B. Licensing Staff observed all materials in this room are safety compliant. The sign in/sign out sheets were complete.

Report Continued on Page 2*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/21/2019
NARRATIVE
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Licensing Staff inspected Room 112 and observed that there thirteen children present and one Teacher Naumen, Sharon and one Teachers Aide, Trujillo, Sonia. Licensing Staff observed the teacher/child ratio was complete. Licensing Staff observed there was a working smoke/carbon monoxide detector and 3A40BC fire extinguisher last serviced 12/18/2018. All cleaning products/similar items are stored inaccessible to children in Room 112. Licensing Staff observed all materials in this room were safety compliant. The sign in/sign out sheets were complete. There is no bathroom in this room. The children use the bathroom beside the cafeteria. The girls bathroom has three toilets and two sinks. The boys bathroom has one toilet, three urinals and two sinks. There is a waiver on file for the shared bathroom use with the elementary school children. The waiver states children will have exclusive use while in the bathroom. Licensing Staff observed a bathroom schedule posted. Licensing staff observed compliance of the waiver. Licensing staff discussed with Flynn, Wendy that there needs to be an updated schedule for the bathroom use. The current schedule does not cover the entire school day.

Licensing Staff inspected Room 1 and observed that there fourteen children present and one Teacher Paula and one Teachers Aide, Choi, Faith. Licensing Staff observed there is a working smoke/carbon monoxide detector, 3A40BC fire extinguisher in the alcove between Room 1 and Room 2. All cleaning products and similar items are stored inaccessible to children in Room 1. Licensing Staff observed all materials in this room were safety compliant. The sign in/sign out sheets were complete. There is a bathroom with one toilet and one sink. Licensing staff observed children eating snacks, grapes and animal crackers. Licensing staff observed two food groups were being given to children during snack break.

Report Continued on Page 3*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/21/2019
NARRATIVE
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Licensing staff conducted an exit interview with Flynn, Wendy.

The following Type B deficiencies noted on the attached page (809-D): Appeal rights provided to Flynn, Wendy prior to the conclusion of today's inspection.


NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 9 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited
CCR
101216.3(a)
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Teacher Child Ratio:A ratio of one fully qualified teacher (as specified in Section 101216.1(c)) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d). This requiremet was failed to be met as evidenced by Licensing Staff observed S4 alone in classroom A with children, did not have evidence of being a fully qualifiied teacher, on file.
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Director Flynn, Wendy will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of units and verified work history for staff 4, 5 and 8.
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S5 alone in classroom B with children, did not have evidence of being a fully qualifiied teacher, on file. S8 in classroom 2 with a Teachers Aide and children, did not have evidence of being a fully qualifiied teacher, on file. This poses a potential risk to the health and safety of the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/21/2019
NARRATIVE
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Licensing Staff inspected Room 2 and observed that there thirteen children present and two adults Hernandez, Shannon and Cuevas, Kathy. Licensing Staff observed there is a working smoke/carbon monoxide detector, 3A40BC and cleaning products/similar items are stored inaccessible to children in Room 2. Licensing Staff observed all materials in this room were safety compliant. The sign in/out sheets were complete. Licensing staff observed children eating snacks, grapes and animal crackers. Licensing staff observed two food groups were being given to children during snack break.

Licensing Staff inspected the cafeteria there is a working smoke/carbon monoxide detector, clean and functioning refrigerators. Licensing Staff observed an open container of Borax and Fabreze air Freshener spray accessible to the children in care. The Director Flynn, Wendy stated the cafeteria is used by grades 1 through 3 when there is inclement weather. Licensing staff discussed with Flynn, Wendy that a schedule needs to be submitted for the cafeteria, since it is a shared space.

Licensing Staff inspected the outdoor areas of the facility. Licensing staff observed the outdoor area has sufficient equipment. There is shading through trees and a canopy on the play ground. The playground is appropriately fenced and has cushioned material on the surface of the play ground. Licensing Staff observed cracks in the pavement surrounding the playground causing the surface to be uneven. Licensing Staff discussed with Flynn, Wendy the need to repair the cracks in the ground as a safety precaution.

Licensing Staff observed the required postings in the facility. Licensing Staff reviewed nine staff files, six Teachers, two Teachers Assistants and one Directors file. Licensing Staff reviewed ten children's files. Licensing Staff observed a current roster, a current fire disaster/earthquake drills last log 06/28/2019. Licensing Staff reviewed ten children files and observed some records incomplete and need to be updated, see 809 D.

Report Continued on Page 4*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/21/2019
NARRATIVE
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This facility provides Incidental Medical Services – IMS. Licensing Staff reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

A review of staff records on 08/20/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensing Staff reminded Flynn, Wendy 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. 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 violation within a 12-month period.Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates



Licensing staff discussed with Flynn, Wendy that an updated sketch of the playground needs to be submitted and a schedule for the shared bathroom. Licensing staff discussed with Flynn, Wendy the requirements for use of a shared cafeteria. Director understand a schedule and waiver request must be submitted to the department for continued use of the shared cafeteria.

Report Continued on Page 5*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited
CCR
101215.1(m)
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Child Care Center Directors Qualifications and Duties: A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866 This requirement was failed to be met as evidenced by licensing staff observed there was no proof of eight hours of
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Staff One will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of preventative health training..
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preventative health and safety training for staff 1. This poses a potential risk to the health and safety of the children in care.
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Type B
09/23/2019
Section Cited
CCR
101221(a)(8)
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Chidlrens Records: A separate, complete and current record for each child is maintained in the child care center. Medical assessment... This requirement was failed to be met as evidenced by licensing staff observed there was no 701 form in child 4's file. Chilld was enrolled 06/24/2019. This poses a potential risk to the health and safety of the children in care.
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Director Flynn, Wendy will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of 701 form for child 4.
Type B
09/23/2019
Section Cited
HSC
1596.866(b)(1).
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 Health and Safety Code: a person who, on January 1, 2018...an employee of a licensed child day care facility shall complete the mandated reporter training...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 was failed to be met as evidenced by licensing staff observed staff 8 did not have completion.
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Director Flynn, Wendy will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of mandated reporter training for staff 8.
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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited
HSC
1596.7995(a)(1)
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Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Director Flynn, Wendy will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of immunizations for staff 8 and 9.
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This requirement was failed to be met as evidenced by licensing staff observed Staff 8 had no record of TDAP or Flu vaccination. Staff 9 had no record of any of the required immunizations on file. This poses a potentail risk to the health and safety of the children in care.
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Type B
09/23/2019
Section Cited
CCR
101216.1(c)(1)
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Teacher Qualifications: To be a fully qualified teacher, a teacher shall have one of the following:) Twelve postsecondary semester or equivalent units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed care program.
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Director Flynn, Wendy will send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019 for proof of completion of units and verified work history for staff 4, 5 and 8.
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This requirement was failed to be met as evidenced by licensing staff observed S4 had nine verified ECE units no verification of work history. S8 does not have verification of relevant work history. S5 did not have proof of family child and community class completion. Therefor there is insufficient evidence to verify they meet the requirements. This poses a potential risk to the health and safety of the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2019
Section Cited
CCR
101238(g)
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Buildings and Grouds: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.This requirement was failed to be met as evidenced by licensing staff observed Borax and Fabreze under the sink in the cafeteria. This poses a potential risk to the health and safety of the children in care.
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Director Flynn, Wendy immediated moved the products and stored them in an inaccessible area. Director Flynn, Wendy understands the potential risks to the children in care and has stated the facility will be checked to ensure this risk does not take place.
Type B
09/23/2019
Section Cited
CCR
101238.2(d)(2)
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Outdoor Activity Space: The surface of the outdoor activity space shall be maintained:(2)Free of hazards including, but not limited to, holes....This requirement was failed to be met as evidenced by licensing staff observed holes and cracks in the pavement in the playgroud area. This poses a potential risk to the health and safety of the chidlren in care.
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Director Flynn, Wendy will insure repair of pavement and send licensing staff photographic evidence via mail, email photo, fax or text photo on or before 09/23/2019. Please note fax number is 408-324-2160.
Type B
09/23/2019
Section Cited
CCR
101219(b)
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Admission agreements: Admission agreements shall specify the following: This requirement was failed to be met as evidenced by licensing staff observed although child one through ten had admission agreements there was not basic/optional services, modification term, licensing inspection authority or conditions for
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Director Flynn, Wendy will update the admission agreement to meet all the regulatory requirements. Obtain new signed admission agreements and provide copies to licensing staff via mail, fax, email photo and/or text photo. This will be sent on or before 09/23/2019 for children one through ten. This agreement needs to be updated for all children in care.
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termination. This poses a potential risk to the health and safety of the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 9