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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414765
Report Date: 01/08/2025
Date Signed: 01/08/2025 01:46:13 PM

Document Has Been Signed on 01/08/2025 01:46 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:CREC PRESCHOOL IN UNIONFACILITY NUMBER:
434414765
ADMINISTRATOR/
DIRECTOR:		JU, GINFACILITY TYPE:
850
ADDRESS:20900 STEVENS CREEK BLVD.TELEPHONE:
(408) 593-7777
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 28DATE:
01/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Stephanie TienTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 1/8/2025, at 9:35 AM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conduct a Required 1-Year Inspection and was greeted by Stephanie Tien, Program Director (PD). LPA toured the indoor and outdoor areas of the Facility with Director during today's inspection. Shortly after, approximately 11:54AM, Licensee, Gin, Lu arrived and met with LPA.

LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Days and hours of operation are Monday through Friday 7:00AM to 6:00PM.

LPA reviewed five (5) children's and four (4) staff files during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). Staff files reviewed contain the required forms/documents, including current CPR and First Aid certifications on file. All staff members had current Mandated Reporter Training on File. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during any off-site activities. Last fire/disaster drill was completed on 12/13/2024.



LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 4 Staff and 28 Children during today's inspection; a review of children roster indicated no children are under 2 years of age. LPA confirmed with director that there is no toddler component. Director understands the conditions, limitations, and capacity specifications of the Facility license. She understands that children shall be always visually supervised. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted into care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. Continue on page 2...
Gladys KuizonTELEPHONE: (510) 566-5850
Liridon FiciTELEPHONE: 408-598-9250
DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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 01/08/2025 01:46 PM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CREC PRESCHOOL IN UNION
FACILITY NUMBER: 434414765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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 Based on observation, the licensee did not comply with the section cited above by leaving resolve and Lysol clearer and disinfectant supplies accessible to children in the class located to the right side of the class at the corner, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 01/09/2025
Plan of Correction
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Deficiency cleared
Staff removed the cleaners and disinfectant and locked them up in an inaccessible area of the class where children can not reach them.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Gladys KuizonTELEPHONE: (510) 566-5850
Liridon FiciTELEPHONE: 408-598-9250

DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/08/2025 01:46 PM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CREC PRESCHOOL IN UNION
FACILITY NUMBER: 434414765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Interview and record review, the licensee did not comply with the section cited above by not having current mandated reporting training for Staff 1 on file, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee agreed to have Staff 1 complete mandated reporting training and to submit proof of completion to CCL by POC due date.
Section Cited
Child's Medical Assessments
(b) The medical assessment shall provide the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not having a current medical assessment (Physicians report) for Child 2 on file, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee agreed to have Child 2's parent(s) complete the medical assessment (Physicians report) and to submit proof of completion to CCL by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys KuizonTELEPHONE: (510) 566-5850
Liridon FiciTELEPHONE: 408-598-9250

DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025

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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: CREC PRESCHOOL IN UNION
FACILITY NUMBER: 434414765
VISIT DATE: 01/08/2025
NARRATIVE
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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Director states that the Facility has Janitorial Cleaning Service that comes in Monday through Friday, after hours once all staff and children are gone. Director understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that furniture and equipment is in good condition and safe for the children. Children have their own water bottles labeled with their name on it, when playing outdoors there are water cooler stations for the children along with, they have their water bottles.

LPA observed there is cold running water, refrigerator, and microwave on the premises. Lunch is bought in from parents and warmed up at the center for children to have, and PM snacks are provided by the facility. The Facility has trash cans with tight fitting lids for solid waste in the classroom. LPA observed a complete first aid kit available in the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by big trees and building that is blocking the sun. There are sufficient resilient materials on the outdoor playground area. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation for preschool children.

Director 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.

This facility does provide Incidental Medical Services (IMS) at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Childcare 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. LPA observed an IMS plan on file. Continue on page 3...
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CREC PRESCHOOL IN UNION
FACILITY NUMBER: 434414765
VISIT DATE: 01/08/2025
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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.
For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Director understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

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

LPA provided Director with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School

https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies

https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx



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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CREC PRESCHOOL IN UNION
FACILITY NUMBER: 434414765
VISIT DATE: 01/08/2025
NARRATIVE
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The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A Notice of Site Visit was given and must remain posted for 30 days.

LPA Liridon Fici- Doni informed licensee, Gin, Lu that this report, dated 1/8/2025 document(s) one (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Doni, informed the licensee to provide a copy of this licensing report, dated 1/8/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted with Licensee, and a copy of this report review and provided along with appeal rights.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
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