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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700114
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:42:22 PM

Document Has Been Signed on 04/03/2024 02:42 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCAREFACILITY NUMBER:
430700114
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		RACHEL SAYREFACILITY TYPE:
850
ADDRESS:5303 CARTER AVENUETELEPHONE:
(408) 265-3580
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 60TOTAL ENROLLED CHILDREN: 33CENSUS: 27DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
01:02 PM
MET WITH:Rachel SayreTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
02:53 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Rachel Sayre, to follow up on incident that occurred on 3/25/2024. Upon arrival, LPA was admitted into the facility by a staff member and Rachel arrived shortly after. During today's visit, LPA conducted interviews with staff and the Site Director and reviewed the outside area where the incident occurred.

The facility self-reported the incident to the Department on the day of its occurrence, 3/25/2024. On that day, C1 was left outside for approximately one minute during a transition time from outside play to inside play. C1 was noticed outside by S1 and was redirected to the classroom. S2 brought the child back into the classroom and consoled the child.

Since the day of the incident, Rachel states that she has conducted follow-up discussions with the staff members who were present and will be having a staff meeting tomorrow (4/4) to discuss strategies to prevent another incident like this from occurring again. There are planned changes for transition time, such as name to face counting, classroom transitions at the same time, and having aides do an additional sweep of the outside yard before closing the doors. The parent of C1 was notified by Rachel of the incidents occurrence.

LPA observed that the outside area for children is completely fenced in and C1 was safe during the duration of being left outside. Staff quickly realized C1 was outside and responded to the situation within a minute of it occurring. No staff were present outside when C1 was outside unattended.

LPA informed licensee (Rachel Sayre) that this report dated (4/3/2024) documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE
FACILITY NUMBER: 430700114
VISIT DATE: 04/03/2024
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Also, LPA informed the licensee to provide a copy of this licensing report dated (4/3/2024) that documents any Type A citation 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.

As a result of today's inspection, a deficiency has been cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Site Director, Rachel Sayre.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/03/2024 02:42 PM - It Cannot Be Edited


Created By: Cortney Nelson On 04/03/2024 at 02:12 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: CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE
FACILITY NUMBER: 430700114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time..Supervision shall include visual observation.

This requirement was not met as evidenced by:
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The Site Director states that she plans to host a staff meeting regarding transitions and maintaining numbers tomorrow (4/4). Additionally, follow up has been conducted 1:1 with staff that were present on the day of the incident and a memo was sent to all staff regarding the incident.
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The facility staff did not ensure that chilren in care were visually supervised at all times as C1 was left outside during transition for approximately one minute, which poses an immediate risk to the health, safety, and personal rights of children in care.
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The staff meeting shall discuss strategies for ensuring children are accounted for including name to face counting, classrooms transitioning at the same time, or utilizing an aide to double check the playground.

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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