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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412730
Report Date: 07/28/2022
Date Signed: 07/28/2022 01:02:20 PM


Document Has Been Signed on 07/28/2022 01:02 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:LEGACY CHRISTIAN PRESCHOOLFACILITY NUMBER:
434412730
ADMINISTRATOR:LUCY NUNEZFACILITY TYPE:
850
ADDRESS:420 ALLEGAN CIRCLETELEPHONE:
(408) 225-5976
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:100CENSUS: 41DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Paula OlsonTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz met with Paula Olson, fully qualified teacher for an unannounced Required- 1 Year inspection. Paula stated that the Director, Lucy Nunez, is currently on vacation and will be back on 08/01/22. LPA toured the indoor and outdoor areas of the facility during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610)Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. Days and hours of operations are Monday through Friday 7:00 AM to 6:00PM.

LPA reviewed 10 children's files and six staff files (five teachers and one teacher aid) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and all required licensing forms. All staff files reviewed contain the required transcripts/verification of experience, immunization records, and Health Screening Report. LPA reviewed current certificates of completion of the Mandated Reporter Training for Child Care Workers for all staff on file . LPA also reviewed current CPR and First Aid certifications of staff present on file. Paula understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during outdoor activities. Sign in and sign out sheets are in compliance.



LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 41 preschool children, with five fully qualified teachers and a teacher aid present . Paula understands the conditions, limitations, and capacity specifications of the Facility license. Paula understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the copy room area of the facility's office.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
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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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: 07/28/2022
NARRATIVE
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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Paula understands that the facility must be kept free of insects & rodents. LPA observed that all furniture and equipment are in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water refillable jug. Staff and children's bathrooms are clean, sanitary, and in working order. There is a separate staff bathroom not utilized by the children. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors indoors. Last fire drill was done on March 31, 2022.

LPA observed the food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. There is also running water in sinks inside the classrooms, and a refrigerator on the premises. Paula stated The Facility provides AM/PM snacks and children bring their own lunch and water bottles. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in locked cabinets LPA observed a complete First Aid kit, including touch less thermometer, in the Facility.

LPA inspected outdoor equipment for safety, cushioning material and good repair. Adequate shade provided by trees and sunshade canopies, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. No hazards or bodies of water observed. Sand box is covered at the end of each day, and inspected before each use. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. Paula states that the Facility does not provide transportation.

LPA observed sufficient infant napping equipment that meets requirements of Title 22 regulations. Mats/cots and beddings inspected for good condition, have appropriate storage and cleanliness.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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: 07/28/2022
NARRATIVE
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Paula was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

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/inspection-process


Exit interview conducted and report was reviewed with Teacher, Paula Olson. A deficiency was cited during today's inspection.


A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/28/2022 01:02 PM - It Cannot Be Edited

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: 07/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. One of the teachers does not have proof of measles vaccination prior to employment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2022
Plan of Correction
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Licensee will submit to LPA Cruz proof of measles vaccination for one preschool teacher identified.
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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4