434412730-7-8-2021-07-CC-AALZ-C4R4R2-20210708191912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412730
Report Date: 07/08/2021
Date Signed: 07/08/2021 07:19:55 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 PRESCHOOL		FACILITY NUMBER:	434412730
ADMINISTRATOR:	DEBBIE HUDSON		FACILITY TYPE:	850
ADDRESS:	420 ALLEGAN CIRCLE		TELEPHONE:	(408) 225-5976
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	100	CENSUS: 28	DATE:	07/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Nunez, Lucy		TIME COMPLETED:	06:30 PM

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	On this day, Licensing Program Analyst (LPA) Almaraz, Celi. conducted an unannounced annual random Inspection. This is a preschool program that is currently licensed for a capacity of 100, upon arrival there was a total census of 28 children and 5 staff. Licensing staff met with Director Nunez, Lucy. This program currently operates 8:00 AM to 5:00 PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. All areas identified on the Facility Sketch were inspected. This facility is on the campus of Legacy Christian Elementary School. This facility consists of 5 rooms. Due to lower enrollment the rooms are currently being used as combined; 1 and 2, 3 and 4 (A & B) Room 5 (112), room 113 (cafeteria). Room 5 can currently be used as an isolation room. There is waiver on file for shared bathroom use, which is on the school campus. LPA observed compliance with the waiver. This is currently not being used due to lower enrollment. The following was observed by LPA Almaraz: Physical Plant: LPA observed the following of all rooms: Rooms 1 to 2: Upon arrival room had one teachers, one aide, 14 preschoolers (three to four years old. Rooms are adjacent with a mirror setup. Access to two toilets, two drop in sinks and two drinking fountains (one of each per room), located inside classroom. Children bring water bottles. Teacher and child ratios were observed and staff names recorded. Rooms 3 and 4: Upon arrival room had one teacher, one aide with 14 preschoolers (4 and 5 years). Room are adjacent with a mirror set up. Where rooms join there is a lavatory area with three toilets, two hand wash sinks and two drinking fountains. Children bring water bottles. Teacher and child ratios were observed and staff names recorded. Room 112: There were no children or staff present in this room. There is a waiver to access a total of four toilets, three urinals, four sinks, which is part of elementary school. Director states when room is in use there will be two staff placed in this room. LPA observed an interviewee for this purpose upon arrival. Director will ensure supervision to stay in compliance with waiver and ratio. Drinking water located inside classroom, there is one drop in sink with one drinking fountain. Children bring water bottles. This room is used for 5 and 6 year olds when in use. Room 113: This is a cafeteria, there is access to 2 sinks and two drinking fountains. Children currently eat in classrooms.*****1/4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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 4

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: 07/08/2021

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

Room 113: This cafeteria is shared with the elementary school. Children currently eat in class rooms. Director states if cafeteria is used in the future, scheduling and supervision will ensure no commingling.

Furniture and equipment: All furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have labeled cubby's to store belongings. Availability of drinking water was reviewed. Toys observed to be clean. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in good condition with a foot petal Director states waste is to be discarded immediately after each meal.

Menus: Menus are posted monthly and in advance, where it is visible by the child's authorized representative. Menus for the quarter are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides AM and PM snacks. Hot lunch will be offered in the fall of 2021; children bring their own lunch. Snack menus were reviewed. Food preparation areas were toured for safety, cleanliness and proper equipment. Refrigerators reviewed for appropriate temperature. Kitchen area where food stored in bins (with tight fitting lids) was observed to the clean.

Napping equipment: Mats and cots along with bedding inspected for good condition, appropriate storage and cleanliness. Parents take linens home on Friday and returned Monday, if soiled sent home same day. There are clean extra linens in classrooms in the event of an accident. Director states mats are sanitized daily. For the rooms that use cots, these are stored on stackable cot divider with name labels, sanitized the end of each week. LPA observed children sleeping at least six feet apart, side to side and three feet head to toe.

Personal Rights: Teacher-child ratios were observed, staff names recorded. Care and supervision was evaluated to determine if basic needs and personal rights of children are being met and appropriate.

Incidental Medical Services. 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 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*****2/4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 07/08/2021

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

Lavatories: Restrooms/lavatories inspected. Age appropriate sinks and toilets were inspected for availability and sufficient condition in all restrooms. Sinks/toilets also inspected for water temperature, toilet paper, area safety and sanitation. LPA Almaraz observed the children's sinks are in working condition and meet licensing standards. LPA Almaraz observed soap dispenser and disposable towels in all preschool lavatories. Staff has one separate bathroom. A sick child can currently isolate in the bathroom with waiver since it is not being used. There is also an extra one in the main office, that is not used and can be if needed. Upon full enrollment there is an unused office that a sick can isolate in. There is a total of nine toilets, three urinals, 11 sinks and 6 drinking fountains available to children in care.

First Aid and Fire safety: First Aid supplies and backpacks were observed in the classrooms According to Director medication is only administered to a child when accompanied with a doctor's note and is stored in the back packs that are kept out of reach. For best practice Director will place Epi pen/medications in lock box inside back packs. Teachers carry keys on them at all times. Carbon monoxide detectors and smoke detectors are and working present in the facility. There are fire extinguisher access in all rooms, size 3A40BC, last serviced on 12/29/2020. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Last fire drill was 03/11/2021; Director understand the requirement to conduct fire/disaster drills every 6 months. The emergency exit doors are accessible. The emergency disaster plan is posted in an area where it is visible to staff , parents and authorized parent representatives.

Outdoor playgrounds: Outdoor playground equipment is in a safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Children bring water bottles and can refill in outdoor drinking fountain. Director will also bring water pitcher upon more enrollment. During the school year kindergarten shares this play ground, schedule differentials and supervision ensures no commingling. In a 2019 annual inspection Licensing Staff observed cracks in the pavement surrounding the playground causing the surface to be uneven. A type B citation was issued for the cracks in the ground to be filled in as a safety precaution. The former Director did submit a plan of correction. The current pavement is safety compliant but there are hints of cracking beginning in the pavement again. LPA and Director discussed getting this repaired as soon as possible, to ensure this does not become a safety hazard again. Also discussed was getting more shading and placing mesh in the inner part of the fence for best practice. The fence shows signs of distress. *****3/4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 07/08/2021

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

Facility Records: LPA obtained current children's roster. Sign-in and out sheets and procedures were reviewed. Children’s Records were reviewed for completeness; Inspection of required forms was made. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. Criminal Record Clearances were reviewed for adults. At least one staff has valid CPR card (expires 02/01/2022) Inspection of required postings. Drop off/pick up at door being done. Director states RAST procedures are still being followed, including social distancing protocols, sanitation of commonly used area at least once daily and as needed. Disinfecting in between the use of bathroom and temperature checks.

The following was discussed with Director: Rooms off-limits must be made inaccessible during operating hours. Safety knobs advised. Smoking is prohibited. Inaccessibility of hazards must be constantly reassessed. Stay informed on PIN updates via email. SB792 (Immunization Requirements for Staff and Employees) was discussed. AB1207 Mandated Child Abuse Reporting –Staff shall complete the training and renew every 2 years.
The fire extinguisher type 2A40BC or larger must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. To access forms and Regulations go online www.ccld.ca.gov. Director understands its his/her responsibility to know the regulations as well as anyone who assists in providing care. Adult 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Visit www.shotsforschool.org for immunization information.
In/outdoor supervision required at all times. These forms may also be downloaded from our website: www.ccld.ca.gov There are no deficiencies cited during today's visit in accordance with the California Code of Regulations, Title 22, Division 12, Chapter 1, NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.*****4/4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4