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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414131
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:27:40 AM


Document Has Been Signed on 05/24/2023 10:27 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SARATOGA FRENCH CULTURAL PRESCHOOLFACILITY NUMBER:
434414131
ADMINISTRATOR:BOUGACHOUCH, NADIAFACILITY TYPE:
850
ADDRESS:12850 SARATOGA AVENUETELEPHONE:
(408) 740-3350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:45CENSUS: 14DATE:
05/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Nadia BougachouchTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Pete Hernandez and Marilou Monico conducted an unannounced case management inspection and met with Director Nadia Bougachouch.

On 04/27/2023, LPA Pete Hernandez and Marilou Monico during an interview with staff (S1), S1
admitted pointing a functioning leaf blower at children. S1 claims to have done this to play with the children and only upon their permission. The intended use of a leaf blower is not as a toy. This creates a potential hazard to children in care.

A deficiency is being cited in accordance with the California Code of Regulations, Title 22. See LIC809-D. An exit interview was conducted. A copy of this report and appeals rights were discussed and left with the Licensee/Director, Nadia Bougachouch, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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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Document Has Been Signed on 05/24/2023 10:27 AM - 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: SARATOGA FRENCH CULTURAL PRESCHOOL
FACILITY NUMBER: 434414131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights 101223(a)(2): (a)The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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BY POC DUE DATE, Director will send to Licensing Office a plan of action on how facility will ensure that staff or volunteers will not use the leaf blower as a toy when caring for the children
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(S1) admitted the use a leaf blower on the children while in care. This poses a potential risk to the health and safety of 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: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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