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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413132
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:48:16 PM

Document Has Been Signed on 07/06/2023 02:48 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:NORTHMINSTER PRESBYTERIAN INFANT CAREFACILITY NUMBER:
274413132
ADMINISTRATOR:ANDY RAUSCHFACILITY TYPE:
830
ADDRESS:315 EAST ALVIN AVENUETELEPHONE:
(831) 449-2717
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Jerrianna HagioTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Macias conducted an unannounced Case Management Inspection. LPA met with the Acting Director Jerrianna Hagio, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays visit. LPA noted the Facility also has a preschool program (#270700474) on site in the preschool rooms. The hours of operation are Monday - Friday, 7am - 5:30pm.

Upon arrival LPA Macias was made aware that Jerianna Hagio was acting in the capacity of the center Director. The center has been in transition since the retirement of a long term Director. The facility has not submitted a completed director packet to Community Care Licensing (CCL) for review. Acting Director Jerianna Hagio has been operating as the director for 30 days. LPA Macias explained the importance of the reporting requirements.

Reviewing that each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following: 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). LPA Macias provided the new director - required documentation checklist to the Acting Director Jerianna Hagio. LPA Macias informed the Acting Director that all requested documents must be submitted prior to Hagio instalment as the permanent facility Director.

Type B deficiency cited, exit interview conducted, and a copy of this report was reviewed with the Acting Director Jerianna Hagio. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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Document Has Been Signed on 07/06/2023 02:48 PM - It Cannot Be Edited


Created By: Joseph Macias On 07/06/2023 at 01:46 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: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2023
Section Cited
CCR
101212(b)

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Reporting Requirements:
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).
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The Licensee will submit a complete Director packet on behalf of Jerianna Hagio for review. The Licensee/ Acting Director shall submit a letter of understanding. Outlining the reporting requirements, and the responsibility
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The facility has not submitted a completed director packet to Community Care Licensing (CCL) for review. This poses a potential risk to the health, safety, and personal rights of children in care.
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of ensuring any and all changes to the status of the license and the current director are updated as needed.

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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:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023


LIC809 (FAS) - (06/04)
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