434414465-12-16-2022-07-CC-SCOS-CM6KHJ-20221216065512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414465
Report Date: 12/15/2022
Date Signed: 12/16/2022 06:55:21 AM

Document Has Been Signed on 12/16/2022 06:55 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:	PLAY N LEARN PRESCHOOL INC.		FACILITY NUMBER:	434414465
ADMINISTRATOR:	LARIZ, TAMMY		FACILITY TYPE:	850
ADDRESS:	495-505 MASSAR AVENUE		TELEPHONE:	4082692338
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95116
CAPACITY:	71	CENSUS:	DATE:	12/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Yvonne Co & Tammy Lariz		TIME COMPLETED:	02:25 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	Page 1 Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the School Age Program. LPA met with Director Yvonne Co. and owner Lariz informed them of the purpose of the visit. LPA arrived at the facility at approximately 8:45 AM. Notification of Parents’ Right Poster, Children's Personal Rights, Child Car Seat Laws, Child Care License, LIC 610 Emergency Disaster Form (1 and 2), LIC 308 Designation of Responsibilities, and menu were observed. Facility’s operating days and hours are Monday-Friday 07:30 AM to 05:30 PM. During visit, LPA observed a ratio of two (18) children to 5 staff. All staff present on site are associated to the facility. Facility representative Yvonne Co 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 LPA inspected the building inside and out with Director, The classroom (s), restroom (s) for children to use and office area, storage area, food storage areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions. There is a separate staff rest room. There is a designated area near directors office which sick children can utilize if isolation is require isolation equipment is available .

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PLAY N LEARN PRESCHOOL INC.	FACILITY NUMBER: 434414465
	VISIT DATE: 12/15/2022

NARRATIVE

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There were no Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Children are required to bring there on meals. Facility provides snacks. Trash cans for solid waste had tight-fitting covers on.

The play yard is enclosed by fence. Activity schedule was posted. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children. Shade is provided by trees, canopy and overhang, etc. First Aid kit was inspected. Smoke and

Log recorded that the last fire/disaster drill was conducted on 11/01/22. LPA reviewed There were no Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Children are required to bring there on meals. Facility provides snacks. Trash cans for solid waste had tight-fitting covers on.
facility's sign in/out procedure and record.

A sampling of children and staff files was selected for review. Children records reviewed includes: Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization.

Staff records reviewed include: Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PLAY N LEARN PRESCHOOL INC.	FACILITY NUMBER: 434414465
	VISIT DATE: 12/15/2022

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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.htTo 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.

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.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Yvonne Co.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

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