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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415214
Report Date: 08/09/2024
Date Signed: 08/09/2024 01:27:54 PM

Document Has Been Signed on 08/09/2024 01:27 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:SJB - FRANKLIN CDCFACILITY NUMBER:
434415214
ADMINISTRATOR/
DIRECTOR:		SINDY PULIDOFACILITY TYPE:
850
ADDRESS:420 TULLY ROADTELEPHONE:
(408) 414-2700
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 22DATE:
08/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Maria VelazquezTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Andrea Cortez and Licensing Program Manager (LPM) Gladys Kuizon conducted an unannounced case management inspection in response to an Unusual Incident reported on 7/18/24 by Maria Velazquez, Associate Program Director (APD). LPA/LPM met with APD.

LPA and LPM conducted an inspection toured preschool and pre k classrooms children were eating lunch and preparing for nap time. Preschool child to teacher ratio is 13:3 and Pre K 9:4. During today's inspection LPA and LPM reviewed personnel files for staff.

The center reported on that on 07/17/2024, a child (C1) inserted a bead into C1's nostril and required medical attention to be taken out. The center reported there was a 9:3 child to teacher ratio that day.

The Director explained that C1 was sitting at the table making bracelets out of pasta. Teachers did not observe C1 insert bead into C1's nose. An opportunity may have risen when C1 got up and walked towards the cubby's. C1 told teacher C1 inserted a bead into C1's nose and cannot take it out. C1 was observed and did not have difficulty breathing. Parent was notified right away.

LPA/LPM observed the layout of the classroom and where the activity took place. Classroom was observed to be open to allow for proper visual supervision. LPA/LPM discussed the importance of active supervision with APD.

No deficiencies cited, exit interview conducted, and a copy of this report was reviewed with the APD Maria Velazquez.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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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