434415238-9-19-2023-07-CC-ALOZ-CVTS2U-20230919133006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415238
Report Date: 09/19/2023
Date Signed: 09/19/2023 01:30:13 PM

Document Has Been Signed on 09/19/2023 01:30 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ABC PLAY SCHOOL		FACILITY NUMBER:	434415238
ADMINISTRATOR:	SHU CHEN PAN		FACILITY TYPE:	850
ADDRESS:	3000 SOUTH BASCOM AVENUE		TELEPHONE:	(408) 645-6239
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	35	CENSUS: 27	DATE:	09/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Shu-Chen Pan		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Ashley Lopez conducted an unannounced Annual Required Inspection. LPA first met with teachers, Jacqueline and Fang, who guided LPA on a tour of the facility indoors and outdoors. The Director Shu-Chen Pan then assisted LPA with files and answered all questions. The school consists of 2 classrooms. This program operates hours from 8:00am to 6:00pm Monday through Friday. This facility has a capacity of 35 children, ages 2 to 5 years old. LPA observed that the teacher-child ratio is met. LPA verified that all individuals present have obtained a criminal record clearance or criminal record exemption. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. The facility has only cold water running in the sinks that the children use to wash their hands. Room 2 has an isolation area for a child when they are feeling ill and parents are contacted immediately. The director states they may also use the directors office to isolate a sick child if needed. Food menus are posted at least one week in advance and visible to an authorized representative. Preschoolers are provided with AM/PM snack and Lunch. Hot lunch is provided from a restaurant called Yummy Kitchen and is delivered to the facility daily. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. Children bring their water bottles from home and filtered water is provided from the facility through the sinks. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. LPA reminded the director to keep disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Ashley Lopez	TELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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: ABC PLAY SCHOOL	FACILITY NUMBER: 434415238
	VISIT DATE: 09/19/2023

NARRATIVE

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Facility has functioning smoke detector/carbon monoxide detector. The last fire drill was conducted on 8/30/23. LPA observed a fully charged 3-A-40-BC fire extinguisher in Room 2. The director states that the facility has a third-party cleaning service that comes in Monday through Friday in the evenings. Director understands that the facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. LPA did not observe any bodies of water during the visit. Areas around and/or under climbing equipment and slides have soft cushioning (rubber padding) to absorb a fall. The playground area utilized by children is surrounded by appropriate fencing. Shade is provided by trees, canopy, and building overhang in the playground.

LPA obtained a current copy of the Children's Facility Roster. The facility uses the app ProCare for their Sign In/Out process and LPA observed the electronic Sign In/Out sheets. LPA reviewed 10 children’s and 5 staff files during today's inspection. Children’s Records were reviewed for completeness and Inspection of required forms was made. In review of children’s records, files contain information including: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. Two staff files reviewed were missing the required Health Screening Report (LIC 503). All staff have current certificates of completion of the Mandated Reporter Training for Child Care Providers and have current CPR and First Aid certifications. 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 off-site activities.

Director Shu-Chen understands the conditions, limitations, and capacity specifications of the facility license. The director understands that children shall be visually supervised at all times. LPA observed a complete First Aid kit in each Room. The director states they will administer medication to children, but they do not have any currently enrolled children who have medication.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Ashley Lopez	TELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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: ABC PLAY SCHOOL	FACILITY NUMBER: 434415238
	VISIT DATE: 09/19/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed with the director. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

As a result of this inspection, deficiencies are cited on the following page LIC 809D.

Exit interview conducted and report was reviewed with the director Shu-Chen Pan.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Ashley Lopez	TELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

Document Has Been Signed on 09/19/2023 01:30 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ABC PLAY SCHOOL	FACILITY NUMBER: 434415238
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, 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:
	Deficient Practice Statement
1 2 3 4	Based on record review, two staff were missing the LIC 503 Health Screening form in their files, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	The director states she will have the two staff complete a Health Screening with their doctor and will submit a copy of the LIC 503 to licensing by the due date 10/20/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Ashley Lopez	TELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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