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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415832
Report Date: 08/06/2024
Date Signed: 08/06/2024 03:44:07 PM

Document Has Been Signed on 08/06/2024 03:44 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-ROULEAU CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434415832
ADMINISTRATOR/
DIRECTOR:		NATIVIDAD DE LA ROSAFACILITY TYPE:
850
ADDRESS:1875 MONROVIA DRIVETELEPHONE:
(408) 573-4713
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:26 PM
MET WITH:Iyare Isibor and Mariel QueTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mandeep Kaur conducted an announced case management inspection to the center today with the purpose of reactivating the child care center license. LPA met with Site Director, Iyare Isibor and Program Compliance Coordinator, Mariel Que. LPA observed there were no children in care. License has been inactive since 12/11/23. The center will be operating Monday through Friday from 07:00 AM to 6:00 PM to serve children ages 18 months to 3 years old in classroom 3.

LPA toured indoor and outdoor areas of the center. Program Compliance Coordinator and Site Director was reminded to conduct the fire/disaster drill every 6 months per Title 22 regulations requirements section 101174 (d). LPA observed a fully charged 3A40BC fire extinguisher that was last serviced in June 2024 and working smoke/Carbon monoxide detectors. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. LPA observed 2 toilets and 2 sinks available for the children. Director and Program Coordinator stated that the Santa clara county office of education department's vendor provides the cleaning service that comes and clean the facility after daycare hours.

The center provides morning snacks, lunch, and afternoon snacks to the children that gets delivered from San Juan facility Kitchen. The classroom is equipped with refrigerators, microwaves, storage space for food, and a sink with hot and cold running water. Healthy beverages requirements were discussed with Site Director and Program Compliance Coordinator. Brita filtered Drinking water will be available for the children indoor via sippy cups or individual water bottles.

The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided. Brita filtered Drinking water will be readily available for the children outdoor via individual water bottles or Sippy cups. There were no bodies of water observed. Site Director and Program Compliance Coordinator stated that there are no we weapons or firearms on the premises.
**Continue on 809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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 3
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: SJB-ROULEAU CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415832
VISIT DATE: 08/06/2024
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**Continuation from 809**
LPA reviewed Site Director's file. Site Director records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. Director’s certifications for CPR and First Aid card is current and will expire on 1/25/25 and Mandated Reporter Training (AB1207) will expire on 02/27/25.

Incidental Medical Services (IMS) policy was discussed. 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/.

Site Director and Program Compliance Coordinator 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.

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 lea d contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care 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).

LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.

**Continue on 809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
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: SJB-ROULEAU CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415832
VISIT DATE: 08/06/2024
NARRATIVE
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**Continuation from 809-C**

Site Director and Program Compliance Coordinator, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

Copy of personnel report and Emergency Disaster Plan for Child care centers were obtained during today's inspection.

No deficiencies were cited today. Exit interview conducted and report was reviewed with Site Director, Iyare Isibor and Program Compliance Coordinator, Mariel Que.

Site Director and Program Compliance Director was notified that license will be activated upon manager's review and approval.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC809 (FAS) - (06/04)
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