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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414756
Report Date: 09/09/2019
Date Signed: 09/09/2019 04:53:10 PM

COMPREHENSIVE INSPECTION
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:SAN JOSE GRAIL FAMILY SERVICESFACILITY NUMBER:
434414756
ADMINISTRATOR:JUANA CASTILLOFACILITY TYPE:
850
ADDRESS:2003 E. SAN ANTONIO STREETTELEPHONE:
(408) 347-7892
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:24CENSUS: 18DATE:
09/09/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Juana CastilloTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Tuoc Doan and Stephanie Collins conducted an unannounced Annual inspection of the Preschool. LPAs met with Director Juana Castillo and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, and LIC613A Personal Rights were observed to be posted. The Preschool operates two sessions Monday through Friday. The AM session runs from 08:30 AM to 11:30 AM and the PM session runs from 01:00 PM to 04:00 PM.

Facility was observed to be in compliance with teacher to child ratio requirement during inspection. Children were under the direct visual supervision of staff. LPAs inspected the building inside and out. The Preschool Room A, children restroom, staff restroom, maintenance/utility storage area, and Offices were inspected. LPAs observed that Room B is no longer used by children and is now used as a multipurpose room for staff and storage of food. Director submitted an updated facility sketch to LPAs during inspection. Removing Room B will reduce the amount of indoor activity space for children; however, based on LPAs' calculation, this change will not affect the currently licensed maximum capacity of 24 children.

Outdoor activity space for the Preschool Program is fenced. Play equipment were maintained in a safe condition and free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. Drinking water is arranged to be readily available for children in care. Shade is provided by trees, building overhang, canopy etc.

There were no bodies of water observed. Director stated that facility does not have weapons on the premises. 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. Floors were clean.
First Aid Kit was inspected. LPAs observed facility has fully charged fire extinguishers last serviced on June 2019, smoke and carbon monoxide detectors, and fire alarm and sprinkler system. Records show that the last fire/disaster drill was conducted on 09/03/19.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
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
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: SAN JOSE GRAIL FAMILY SERVICES
FACILITY NUMBER: 434414756
VISIT DATE: 09/09/2019
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Director stated that currently facility does not have children in care who requires IMS. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

In the areas that were evaluated, regulatory violations were observed at the time of the visit. Exit interview was conducted, where this report, the violations, plan of corrections, and appeal rights were discussed with Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAN JOSE GRAIL FAMILY SERVICES
FACILITY NUMBER: 434414756
VISIT DATE: 09/09/2019
NARRATIVE
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Facility provides snacks to the AM and PM sessions. Food storage and preparation areas were clean, free of litter, and rubbish. Foods and beverages were kept protected against contamination and spoilage. Menu was posted. Trash cans for solid waste have tight fitting lid.

LPAs reviewed sign in and out record and procedure with Director. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, and Immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Education Qualification, Health Screening Report with TB Clearance, Immunization (Measles and Pertussis) record and required Training. LPAs reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility. Director stated facility is not providing transportation to children.

LPAs reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

LPAs also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov
[Shortcut: ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: SAN JOSE GRAIL FAMILY SERVICES
FACILITY NUMBER: 434414756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2019
Section Cited

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PERSONNEL REQUIREMENTS. [...] good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement is not met as evidenced by:
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Per LPA's review of records during the inspection, Staff Paloma Cortez Haro has been working at the facility for more than seven days, but does not have a health screening report with TB clearance. This poses a potential risk to the health and safety of children in care.
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Type B
09/16/2019
Section Cited

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HEALTH & SAFETY CODE. 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. [...] The day care center shall maintain documentation of the required immunizations.
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This requirement is not met as evidenced by: Per LPA's review of files during the inspection, facility does not have documented evidence of Staff Paloma Cortez Haro's immunity against Measles and Pertussis. 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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAN JOSE GRAIL FAMILY SERVICES
FACILITY NUMBER: 434414756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited

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MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].
This requirement is not met as evidenced by:
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Per LPAs' review of files during the inspection, facility does not have staff Paloma Cortez Haro and Maria Ornelas' Certification of Completion for the Child Care Mandated Reporter Training. This poses a potential risk to children's 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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5