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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700594
Report Date: 10/02/2025
Date Signed: 10/03/2025 08:47:14 AM

Document Has Been Signed on 10/03/2025 08:47 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:SAINT ANDREW'S EPISCOPAL SCHOOLFACILITY NUMBER:
430700594
ADMINISTRATOR/
DIRECTOR:		VAN OVEREN, KARENFACILITY TYPE:
850
ADDRESS:13601 SARATOGA AVENUETELEPHONE:
(408) 867-3785
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 19DATE:
10/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Grace ChuTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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On 10/02/2025, Licensing Program Analyst (LPA), Farida Raja, met with Head of Lower School, Grace Chu for an unannounced Annual/Random inspection. The facility is licensed to serve children ages 4-5 years in the PK Room (Room 105). LPA observed the required posted materials in the classroom. Days and hours of operation are Monday through Friday, 8:00 AM to 6:00 PM.

LPA and Grace toured the indoor and outdoor areas of the preschool program during today's inspection. LPA observed 19 children with 4 teachers. Facility was in compliance with teacher to children ratio requirement.

Classroom, children's restrooms, staff restrooms and kitchen were inspected. Children were observed to be finishing lunch under the visual supervision of teachers. Facility has central heating/cooling for comfort of children. Grace states that there are no weapons or firearms on the premises. There is a working telephone at the facility. Disinfectants and cleaning products were stored inaccessible to the children in care. Grace stated that the janitorial service cleans the classroom daily. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed solid waste containers with tight-fitting lids in the rooms. Napping mats are appropriate. Restroom and sink for children was observed to be safe, sanitary, and in working condition. Staff informed LPA that one restroom is not functional as of this morning and they are working to fix it. Staff have separate bathrooms that can be utilized by sick children if needed.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 09/11/2025 which is compliant with the six-month requirement for facilities.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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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: SAINT ANDREW'S EPISCOPAL SCHOOL
FACILITY NUMBER: 430700594
VISIT DATE: 10/02/2025
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Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and drinking water fountains. Water lead testing was completed for the facility and no Action Level Exceedances were reported.

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. LPA provided Grace with a copy of PIN 21-21.1-CCP during today's inspection. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA obtained a copy of the water lead testing results during today's inspection and advised Grace that only water outlets that were tested can be used by children. If additional water outlets are used they need to be tested prior to allowing children access to them.

Parents provide lunch and snacks for the children. Facility provides optional lunch through a third party vendor- My Green Lunch. Facility provide snacks to children that participate in the extended day program from 3 PM- 6 PM. LPA advised Grace to share the menu with authorized representatives of children. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has tan bark as resilient material to absorb falls. Shaded rest area is provided by trees. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. LPA observed several children were missing either the sign in or sign out by authorized representatives. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed 6 children’s files during today's inspection. Each child's file reviewed contained the required forms.

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

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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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: SAINT ANDREW'S EPISCOPAL SCHOOL
FACILITY NUMBER: 430700594
VISIT DATE: 10/02/2025
NARRATIVE
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Two staff files were reviewed. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current 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). Staff, S2 was observed to be missing immunization's against pertussis, measles and influenza (or statement declining the immunization). LPA observed required Mandated Reporter Training on file for all staff and reminded Grace to have staff complete the Mandated Reporter Training for childcare workers instead of the one for school age personnel. Grace stated that they will submit new director documentation for staff, Tammy Pow to LPA by 10/17/2025. Grace stated that staff, S5 who received a denied exemption notification is not present on campus.

Grace 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. Medications at the facility are stored in the office inaccessible to children in care. LPA observed an Epinephrine Autoinjector for child, C7 is expired and was not obtained from authorized representatives in its original labelled container. Isolation of sick child was discussed, and Grace explained that sick children will be isolated in the director's office and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. 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/.


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

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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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: SAINT ANDREW'S EPISCOPAL SCHOOL
FACILITY NUMBER: 430700594
VISIT DATE: 10/02/2025
NARRATIVE
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Facility does not provide transportation to children. Grace 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.

Three Type B deficiencies and one technical violation were cited as a result of today's inspection. Exit interview conducted and report was reviewed with Head of Lower School, Grace Chu.

A 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: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2025 08:47 AM - It Cannot Be Edited


Created By: Farida Raja On 10/02/2025 at 04:47 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: SAINT ANDREW'S EPISCOPAL SCHOOL
FACILITY NUMBER: 430700594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

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 child which poses a potential health, safety or personal rights risk to persons in care. LPA observed that Epinephrine Autoinjector for child, C7 is expired and was not obtained from authorized representatives in its original labelled container.
POC Due Date: 10/17/2025
Plan of Correction
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Grace to return expired medication and submit a written plan of correction to LPA by 10/17/2025.
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

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 several children were missing either the sign in or sign out by authorized representatives.
POC Due Date: 10/17/2025
Plan of Correction
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Grace to submit a written plan of correction to LPA by 10/17/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Farida Raja
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2025


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Document Has Been Signed on 10/03/2025 08:47 AM - It Cannot Be Edited


Created By: Farida Raja On 10/02/2025 at 04:55 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: SAINT ANDREW'S EPISCOPAL SCHOOL
FACILITY NUMBER: 430700594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2025

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 which poses a potential health, safety or personal rights risk to persons in care. Staff, S2 was observed to be missing proof of immunizations, tuberculosis test and health screening report.
POC Due Date: 10/17/2025
Plan of Correction
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Grace to submit missing documents for S2 along with a written plan of correction to LPA by 10/17/2025.
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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Farida Raja
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2025


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