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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701361
Report Date: 04/12/2024
Date Signed: 04/12/2024 12:52:33 PM

Document Has Been Signed on 04/12/2024 12:52 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:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR/
DIRECTOR:		BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 154TOTAL ENROLLED CHILDREN: 222CENSUS: 61DATE:
04/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lucy Nunez and Smriti DattaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mandeep Kaur and Licensing Program Manager(LPM), Joel Segura, conducted an Case Management-Incident inspection, that was self-reported during the visit on 04/12/2024. LPA and LPM met with Site Supervisor, Lucy Nunez and Site Director, Smriti Datta.

Site Supervisor stated that incident happened on 04/11/2024 around 5:15PM, at where a child (C1) was left alone.
Site Director stated that a child (C1) left the classroom by himself, following a parent. Site Director stated that a child (C1) was found in the preschool parking lot.

Based on interviews, a child (C1) was left alone unsupervised outside and was found in the parking lot.

Site Director stated that the training on supervision and children safety will be provided to the staff and the teacher involved is being terminated on 04/12/2024.

As a result of this inspection, Type A citation was issued. Exit interview conducted and report was reviewed with Site Director, Smriti Datta. A notice of site visit has been issued and must remain posted for 30 days.

LPA and LPM informed Site Director that this report dated 04/12/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Assembly bill 633 was provided and discussed with Site Director. LPA and LPM informed the Site Director to provide a copy of this licensing report dated 04/11/2024 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 (LIC9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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 04/12/2024 12:52 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 04/12/2024 at 12:03 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: ACTION DAY NURSERY
FACILITY NUMBER: 430701361

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and
Supervision: 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.
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Site Director stated that she is going to submit a written plan of correction by April 15, 2024 to the Department. Site Director stated that training to the staff will be conducted regarding supervision and safety of the children.
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This requirement was not met us evidenced by:
Based on interview, a child (C1) was left alone unsupervised outside and was found in the parking lot on 04/11/2024. This poses an
immediate risk to the health, safety and
personal rights of 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:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


LIC809 (FAS) - (06/04)
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