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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412730
Report Date: 08/11/2025
Date Signed: 08/11/2025 02:44:57 PM

Document Has Been Signed on 08/11/2025 02:44 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LEGACY CHRISTIAN PRESCHOOLFACILITY NUMBER:
434412730
ADMINISTRATOR/
DIRECTOR:		SHANNON HERNANDEZFACILITY TYPE:
850
ADDRESS:420 ALLEGAN CIRCLETELEPHONE:
(408) 225-5976
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 100TOTAL ENROLLED CHILDREN: 35CENSUS: 0DATE:
08/11/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Shannon HernandezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 8/11/2025 at 8:45 am, Licensing Program Analyst (LPA) Andy Yang met with Director Shannon Hernandez for an unannounced annual inspection. Present during the inspection were director, (2) fingerprint-cleared staff, and (0) children in care. The school is currently closed from the Summer Program which ended on the first week of August. School will resume on August 18, 2025. Upon arrival, LPA provided director a copy of the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 7:30 am - 5:30 pm. The facility is located on the campus of Legacy Christian Elementary school.

Classrooms: This facility is licensed with (5) classrooms/rooms (Room # 1, 2, A, 112, & 113), and all are currently in use. Currently used classrooms were inspected for age-appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces. The facility is equipped with telephone service, smoke detectors, carbon monoxide detectors, pull-down fire alarms, and fully charged 2A30BC fire extinguishers that are accessible throughout the facility. Fully stocked first-aid kits available in the classrooms. Bedding is provided by the parents and washed weekly. Drinking water is accessible by children in the classrooms. The isolation area for when a child is sick is the office.

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for day care pre-school age children. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. The requirements of the floor mats, or the cot are in safe conditions. LPA inspected the napping equipment and observed them to be stored in a healthful manner.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Andy Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2025
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 5
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/11/2025
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Food Service Areas: The facility provides AM/PM snacks to children in care. Children bring meals from home. Facility provides catered lunch delivered from a 3rd party vendor if a child chooses to enroll in the lunch program. All center provided food items are properly labeled and stored separately from cleaning supplies. Food prep area is clean, adequately equipped, and free from hazardous materials. Snack menus are posted and were reviewed. Solid waste bins are equipped with tight fitting lids.

Bathrooms: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe, sanitary, and operating condition. The children are able to reach the sinks, toilets, and supplies. The facility has a waiver for shared bathrooms.

Outdoor Play Area: The outdoor play area is fully fenced. All equipment and surfaces are free from hazards. There is ample shade available. There are age-appropriate outdoor toys and materials for the 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. Drinking water is accessible by children when outside. There are no pools or other bodies of water on premises.

Files and Record Keeping Review: LPA reviewed the facility roster and personnel report. All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPA reviewed (3) staff files. Staff files were complete. Every classroom has a fully qualified teacher. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Director’s CPR/First-Aid Certificate is current and expires on 9/2026. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 2/05/2026. LPA reviewed (5) children’s files. Children’s files were complete. The center utilizes an electronic sign-in/out system and is in compliance with sign in and out procedures. Fire/disaster drills are performed at least once every six months. The last drill conducted on 7/21/2025. Per director, there are no firearms on the premises. All required documents, including the menu and waivers are posted in a publicly accessible area.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Andy Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/11/2025
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Record Keeping and Reporting Requirements: 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. 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.

Criminal Record Clearance: 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.

Lead Testing: 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. Facility completed the lead testing on 12/20/2022.

MyChildCarePlan.org: 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.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Andy Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LEGACY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434412730
VISIT DATE: 08/11/2025
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Incidental Medical Services (IMS): This facility does not provide Incidental Medical Services (IMS). LPA observed medications are stored securely and are made inaccessible to children in care. All children’s medications were inspected to ensure that they are properly labeled and in compliance with expiration dates. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/resources/child-care-centers/.

CCLD Information and Updates: 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 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.

CCLD Inspection Process: 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.

No deficiencies cited during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Director Shannon Hernandez.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Andy Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC809 (FAS) - (06/04)
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