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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354403579
Report Date: 05/10/2024
Date Signed: 05/10/2024 01:57:41 PM

Document Has Been Signed on 05/10/2024 01:57 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:SACRED HEART PARISH PRESCHOOLFACILITY NUMBER:
354403579
ADMINISTRATOR/
DIRECTOR:		CONNIE LEE BUMATAYFACILITY TYPE:
850
ADDRESS:670 COLLEGE STREETTELEPHONE:
(831) 637-4157
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 19DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Lydia AnchondoTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva and Licensing Program Manager (LPM) Belinda Devall met with lead teacher Lydia Anchondo for an unannounced Case Management Incident Inspection from a self-reported incident. Present for the inspection was three staff members and 19 preschoolers. Interviews were conducted and facility file was reviewed.

An incident occurred where two children were left unattended in the playground before staff found the children to rejoin the group. An immediate civil penalty of $500 is assessed.

The following type A deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Martha informed lead teacher Lydia Anchondo to provide a copy of this licensing report dated 05/10/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Lead Teacher, Lydia Anchondo. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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 05/10/2024 01:57 PM - It Cannot Be Edited


Created By: Martha Jimenez-Villanueva On 05/10/2024 at 01:04 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: SACRED HEART PARISH PRESCHOOL
FACILITY NUMBER: 354403579

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/11/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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By 05/11/2024, the facility will submit a written plan of ensuring supervision is observed when outdoor activities occur.
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This requirement was not met as evidenced by interviews conducted that two children were left without care and supervision. This poses an immediate risk to the Health, Safety or Personal Rights to 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:Belinda Devall
LICENSING EVALUATOR NAME:Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024


LIC809 (FAS) - (06/04)
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