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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415293
Report Date: 02/23/2023
Date Signed: 02/23/2023 03:44:13 PM

Document Has Been Signed on 02/23/2023 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:AVONDALE EARLY EDUCATION CENTERFACILITY NUMBER:
274415293
ADMINISTRATOR:LUALEMANA, ROXANNEFACILITY TYPE:
850
ADDRESS:1405 LA SALLE AVENUETELEPHONE:
(831) 899-4757
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY: 127TOTAL ENROLLED CHILDREN: 72CENSUS: 61DATE:
02/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Ghennay WoodsTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced case management inspection in response to an unusual incident that the facility self reported to Community Care Licensing (CCL) on February 14, 2023. LPA met with Center Director Ghennay Woods, and explained the nature of today's inspection to her. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. The hours of operation are Monday - Friday, 7am - 5:30pm.

This case management inspection was made to inquire about an unusual incident that occurred on February 14, 2023.

During today's visit LPA Macias toured the facility, interviewed staff, reviewed the LIC 624, and obtained copies of pertinent information. Based on staff interview, as well as the self reported incident report; a child was not afforded dignity and respect by staff member. A child's arm was grabbed as a form of redirection/ getting the child's attention.

The employee involved in the incident has been terminated. The Director has conducted a training on children's personal rights, as well as supervision. The Director will submit training outline, as well as the employee sign in sheet.


Appeal right were printed and reviewed with the Director.

Type B deficiency cited, exit interview conducted, and a copy of this report was reviewed by the Center Director Ghennay Woods.

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: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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 02/23/2023 03:44 PM - It Cannot Be Edited


Created By: Joseph Macias On 02/23/2023 at 03:29 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: AVONDALE EARLY EDUCATION CENTER
FACILITY NUMBER: 274415293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
101223(a)(1)

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Personal Rights:
The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.
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The employee involved in the incident has been terminated. The Director has conducted a training on children's personal rights, as well as supervision. The Director will submit training outline, as well as the employee sign in sheet by the POC date.

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This requirement was not met, as evident by: A child's arm was grabbed as a form of redirection/ getting the child's attention. This poses a potential risk to the health, safety, and personal rights of the children in care.
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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: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023


LIC809 (FAS) - (06/04)
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