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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414131
Report Date: 01/28/2021
Date Signed: 01/29/2021 09:16:43 AM

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:SARATOGA FRENCH CULTURAL PRESCHOOLFACILITY NUMBER:
434414131
ADMINISTRATOR:BOUGACHOUCH, NADIAFACILITY TYPE:
850
ADDRESS:12850 SARATOGA AVENUETELEPHONE:
4087403350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:45CENSUS: 41DATE:
01/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Nadia JorioTIME COMPLETED:
01:40 PM
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On 01/28/2021 at 8:31am: LPA Pete Hernandez contacted Director Nadia Jorio on her cell phone and initiated a FaceTime tele-inspection. Licensing Program Analysts (LPA), Pete Hernandez, made a case management inspection - incident in response to an unusual incident that was self reported by the Licensing Director, Nadia Jorio, on 1/27/2021. During today's inspection, LPA toured the facility and interviewed staff, and parent of child in report. LPA learned that on January 21, 2021, Child 1 had ignored the verbal redirection of a Teacher and intentionally pulled partition rope that caused a shelf to fall over resulting in the breaking of two boxes used for holding toys.

No one was injured as a result of the incident. There was adequate supervision at the time of the incident. The playground shelf was removed from use until it can be secured to the exterior wall. The rope will no longer be secured directly to the shelf.

LPA inspected the physical plant. LPA interviewed staff, and parent. LPA also reviewed incident report. The Director will contact the LPA once the shelf has been secured and will provide a picture to CCLD prior to using the shelf again.

A deficiency is not being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted by Video Conference was reviewed with the licensee. A copy of this report was discussed and provided to the Licensee by email, Nadia Jorio, as proof this form has been confirmed received by "return receipt" of these documents due to Covid-19 shelter in place orders.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021
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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