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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415557
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:22:25 AM


Document Has Been Signed on 04/06/2023 10:22 AM - 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:FOOTHILL HEAD STARTFACILITY NUMBER:
434415557
ADMINISTRATOR:RENEE GARCIAFACILITY TYPE:
850
ADDRESS:2750 RIVERRUN DRIVETELEPHONE:
(408) 392-3891
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:48CENSUS: DATE:
04/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Roopali Born TIME COMPLETED:
11:00 AM
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On 4/6//2023 LPA Pete Hernandez made an unannounced Case Management Visit to the facility in response to an incident that occurred on 3/23/2023.This is a subsequent visit to make a correction to the 809 and 809D page that indicateds a $500 Civil Penalty assessment. This is corrected to reflect the $500 Civil Penalty does no apply under Title 22 Regulation CCR 101197. Thus a civil penalty is not being assessed. LPA's met with Preschool Director Roopali Born and explained the purpose of the visit.

There is an issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency was cited on 3/28/2023 based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D, An exit interview was conducted, and Plan of Corrections were reviewed and developed with the licensee. On 3/28/2023 A copy of this report and appeals rights were discussed and left with the Licensee.
Today.Roopali i Born, whose signature on this form confirm receipt of these revised documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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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