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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274412173
Report Date: 03/05/2025
Date Signed: 04/16/2025 08:41:28 AM

Document Has Been Signed on 04/16/2025 08:41 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:STEVENSON SCHOOLFACILITY NUMBER:
274412173
ADMINISTRATOR/
DIRECTOR:		MOLLY BOZZOFACILITY TYPE:
850
ADDRESS:24800 DOLORES STREETTELEPHONE:
(831) 574-4600
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 16DATE:
03/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Jennifer Rauber and Nifemi OgunsuyiTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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* This report has been amended to correct the date of the inspection from 03/04/2025 to 03/05/2025.
On 03/05/2025 at 12:35pm, Licensing Program Analyst (LPA), Farida Raja, met with staff, Jennifer Rauber for an unannounced annual inspection. Staff stated that Director, Nifemi Ogunsuyi is in a meeting at a different campus. Director arrived around 4:00pm. The facility is licensed to serve children ages 3.5 years to entry into kindergarten in one pre-kindergarten classroom. The center is located on the Stevenson School campus. LPA did not observe all required postings. The postings that were missing include the Emergency Disaster Plan (LIC 610), Notification of Parents' Rights (PUB 393) and Personal Rights (LIC 613A). Days and hours of operation are Monday through Friday, 7:30 am to 4:00 pm.

LPA toured the indoor and outdoor areas during today's inspection. LPA observed 16 children and two staff. Facility was in compliance with teacher to children ratio requirement. Children were observed to be putting away bedding and having afternoon snack. Facility has central heating/cooling for comfort of children. Staff states that there are no weapons or firearms on the premises. There is a working telephone at the facility. Disinfectants, cleaning products, first aid supplies and medicines were stored in high cabinets inaccessible to the children in care. Furniture and equipment were age appropriate and in good condition. LPA observed solid waste containers with tight-fitting lids in the room. Napping mats are appropriate. Restrooms and sinks for children were observed to be safe, sanitary and in working condition. Classroom has two bathrooms and one bathroom can be utilized by sick child if needed. Staff understands that children shall be visually supervised at all times while indoors and outdoors.

LPA observed a fire extinguisher and built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 11/20/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for the children in each room and in the outdoor playground area via individual water bottles, water dispensers and cups. Water lead testing was completed for the facility and no Action Level Exceedances were reported.

Continued on Page 2
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: STEVENSON SCHOOL
FACILITY NUMBER: 274412173
VISIT DATE: 03/05/2025
NARRATIVE
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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 lead 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.

Facility provides snacks to the children in care. Menu was observed to be posted. Children can get lunch from the lunch room or parents can provide lunch to children. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. Classroom has a stove and refrigerator which appear clean.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for children. There is adequate equipment, supplies, and toys for children outdoors. LPA observed that the play equipment is age appropriate and sand box is in good condition and free of hazards. There is sufficient resilient material in the outdoor playground area and under high climbing structures. There are no bodies of water observed. Shade is provided by building overhang.

Children sign in and out procedures and logs were reviewed. LPA observed that some children have not been signed in and reminded staff that all parents/authorized representatives are required to sign children in and out with full legal signatures. Children's roster was reviewed. LPA reviewed six children’s files during today's inspection. All children were observed to be missing the Personal Rights (LIC 613A) and Notifications of Parents' Rights (LIC 995).

Two staff files (S1 and S2) were reviewed. All staff files reviewed contain the required transcripts/verification of experience. Both staff have current pediatric CPR and First Aid certification. 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 (field trips). LPA observed that both staff do not have proof of completion of Mandated Reporter Training's.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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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: STEVENSON SCHOOL
FACILITY NUMBER: 274412173
VISIT DATE: 03/05/2025
NARRATIVE
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Staff, S2 is missing the Health Screening Report (LIC 503), proof of measles and negative tuberculosis test. Based on interview with staff, LPA observed that Licensing has not been informed of Director change and an updated Designation of Facility Responsibility (LIC 308) has not been submitted to the Department within 10 days. LPA reminded Director that the name of a child care director and any fully qualified staff designated to act in the director's absence shall be reported to the Department within 10 days.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. Medication was observed to be stored in high cabinets in the classroom. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the nurse's room and isolation equipment will be provided. Child is always under visual supervision while in care of the facility. 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/.

Facility does not provide transportation to children. Director 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&Rs) throughout California.

Five Type B deficiencies and one technical violation were cited as a result of today's inspection. Exit interview conducted and report was reviewed with Director, Nifemi Ogunsuyi. Appeal rights provided.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

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
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/07/2025 01:34 PM - It Cannot Be Edited


Created By: Farida Raja On 03/05/2025 at 04:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STEVENSON SCHOOL
FACILITY NUMBER: 274412173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101218.1(c)
Admission Procedures and Parental and Authorized Representative's Rights
(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA did not observe all required postings. The postings that were missing include the Emergency Disaster Plan (LIC 610), Notification of Parents' Rights (PUB 393) and Personal Rights (LIC 613A).
POC Due Date: 04/02/2025
Plan of Correction
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Director to submit proof of correction to LPA by 04/02/2025.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for two staff (S1 and S2) which poses a potential health, safety or personal rights risk to persons in care. LPA observed that both staff do not have proof of completion of Mandated Reporter Training's.
POC Due Date: 04/02/2025
Plan of Correction
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Director to submit proof of completed Mandated Reporter Training's for both staff to LPA by plan of correction date of 04/02/2025.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


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Document Has Been Signed on 03/07/2025 01:34 PM - It Cannot Be Edited


Created By: Farida Raja On 03/05/2025 at 04:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STEVENSON SCHOOL
FACILITY NUMBER: 274412173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed that Licensing has not been informed of Director change and an updated Designation of Facility Responsibility (LIC 308) has not been submitted to the Department within 10 days. LPA reminded Director that the name of a child care director and any fully qualified staff designated to act in the director's absence shall be reported to the Department within 10 days.
POC Due Date: 04/02/2025
Plan of Correction
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Director to submit a new director packet along with an updated Designation of Facility Responsibility to LPA by 04/02/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


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Document Has Been Signed on 03/07/2025 01:34 PM - It Cannot Be Edited


Created By: Farida Raja On 03/05/2025 at 04:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STEVENSON SCHOOL
FACILITY NUMBER: 274412173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review the licensee did not comply with the section cited above for one staff (S2) which poses a potential health, safety or personal rights risk to persons in care. Staff, S2 is missing the Health Screening Report (LIC 503), proof of measles and negative tuberculosis test.
POC Due Date: 04/02/2025
Plan of Correction
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Director to submit missing documents for staff, S2 to LPA by 04/02/2025.
Type B
Section Cited
CCR
101218.1(b)
(b) At the time of acceptance of each child in care, the licensee shall inform each child's parent or authorized representative of his/her rights that include, but are not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited abovefor 6 children (C1-C6) which poses a potential health, safety or personal rights risk to persons in care. Children (C1- C6) were observed to be missing the LIC 995A and Personal RIghts (LIC 613A).
POC Due Date: 04/02/2025
Plan of Correction
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Director to submit missing documents to LPA by 04/02/2025.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


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