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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415408
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:12:37 AM

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:HILLSIDE CHRISTIAN PRESCHOOLFACILITY NUMBER:
434415408
ADMINISTRATOR:RICK MAPLESFACILITY TYPE:
850
ADDRESS:545 HILLSDALE AVENUETELEPHONE:
(408) 269-1995
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:45CENSUS: 0DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Patricia ZylkaTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA), Fermin Campos-Jaramillo made an unannounced one year required inspection to the center today. LPA met with teacher Patricia Zylka, and explained the nature of today's inspection to her. LPA observed there were not children in care today, Ms. Zylka stated it is because of the Summer recess. LPA reviewed staff files and found they have current CPR/First Aid certifications. LPA observed posted the following forms: License, Emergency Plan, Parents rights, and Earthquake preparation checklist.

LPA toured the facility inside and outside. LPA observed the center is located in rooms 205, 207, and 209 of the Hillside Church. Staff and children's toilets and sinks are safe and in sanitary operating conditions. LPA observed the storage areas are clean and free of litter. LPA observed disinfectants, cleaning solutions, sharp objects, and other similar items are stored inaccessible to children. LPA observed there is a first aid kit in each classroom and they are inaccessible to children. LPA observed posted a menu with the snacks provided by the center.
LPA observed the center's kitchen is equipped with refrigerator, dishwasher, microwave oven and sink with running water in the food preparation area. Ms. Zylka stated the center is not currently using the kitchen and is not offering meals to the children enrolled. LPA observed the facility has functioning smoke detectors and fire extinguishers type 3A40BC in each classroom. LPA observed that drinking water is readily available indoor via water bottles. LPA observed there are trash cans with tight fitting covers for the disposal of solid waste. LPA observed the center has at least one working Carbon Monoxide detector.
Ms. Zylka states that there are no weapons in the premises. Playground areas are surrounded with appropriate fencing and not bodies of water. LPA observed that all furniture, equipment and playground equipment is safe and in good conditions, free of sharp, loose, or pointed parts. LPA observed that shade in the playgrounds is provided by a tree and a tarp. Ms. Zylka stated that outdoors water is provided via water bottles and water coolers and cups. LPA observed there are wood chips as resilient material under the climbing structures in the playground. LPA observed the center's floors were clean and safe.

REPORT DATED 7/22/21 CONTINUES ON PAGE #2
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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 2
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: HILLSIDE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434415408
VISIT DATE: 07/22/2021
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Report dated 7/22/21 continues from page 1.

LPA observed that a fire drill was documented on 5/21/21. LPA obtained a copy of the children's roster. LPA reviewed a random sample of five children's files and found in them the Identification and Emergency Information form, the Physician Report form, the Child Preadmission Health Report form, and the Parents Rights form. LPA reviewed the sign-in, sign-out sheets and are signed with full signatures. LPA observed there was a medical assessment document and a preadmission health history document in each child’s record. LPA observed there are records in each personnel file documenting the educational background of the staff.
LPA observed on the Guardian System report dated 7/06/21 that all the center's staff has obtained criminal records clearance or exemptions. LPA reminded Ms.Zylka 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month-period.
Ms. Zylka stated there are not children under medication currently enrolled in the center.
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.
LPA observed that all the staff has obtained proof of completion of the mandated reporter training AB1207. LPA referred Ms. Zylka to the Department website: www.mandatedreporterca.com for additional information on the online training. LPA observed that all the members of the staff have proof of immunization for measles, pertussis and influenza in file in compliance with the SB792.
There were not deficiencies cited during today's inspection.
Exit interview was conducted with Ms. Zylka. Licensee rights form was printed and handed to Ms. Zylka.
LPA provided Ms. Zylka with the notice of site visit which has to be visible posted for the following 30 consecutive days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2