<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702131
Report Date: 09/04/2024
Date Signed: 10/14/2024 10:00:23 AM

Document Has Been Signed on 10/14/2024 10:00 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:EAST VALLEY CHRISTIAN PRESCHOOLFACILITY NUMBER:
430702131
ADMINISTRATOR/
DIRECTOR:		CHRISTINE BELTRANFACILITY TYPE:
850
ADDRESS:2715 SOUTH WHITE ROADTELEPHONE:
(408) 270-2560
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 144TOTAL ENROLLED CHILDREN: 70CENSUS: 57DATE:
09/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Christine Beltran and Dora CortezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
*This report is amended to remove the two civil penalties issued during this inspection.

On 09/04/2024 at 1:05pm, Licensing Program Analyst (LPA), Farida Raja conducted an unannounced case management- deficiencies visit to follow-up of the deficiencies cited during the annual inspection conducted on 07/24/2024. LPA met with Director, Christine Beltran and explained the purpose of today’s inspection. Director was leaving for an appointment. LPA reminded Director that a fully qualified staff as stated on the Designation of Facility Responsibility (LIC 308) needs to be present in the absence of the director. For absences over 30 days Director will need to submit all required forms for an assistant director within 10 days. Based on interview and record review, LPA observed staff, Dora Cortez is designated to act in Director's absence but is not a fully qualified teacher. Director stated that she will update the LIC 308 and Personnel Report (LIC 500) and submit to LPA.

LPA conducted a facility walk through with staff, Dora Cortez and observed the following ratios:

Room K-112 (2-3 years): 21 children and 1 teacher

Room K-113 (3-4 years): 18 children and 1 teacher

Room K-114 (4-5 years): 18 children and 1 teachers

LPA reviewed staff immunization's. Dora stated that teachers, S1, S2 and S4 are no longer employed with this facility. Immunization's for staff, S3 and S5 were submitted and citation was cleared during today's inspection. LPA reviewed one staff (S6) file during today's inspection. S6 does not have proof of immunization for measles, pertussis and influenza. Staff, S6 is missing proof of completion of Mandated Reporter Training as well. LPA reminded Dora that all adults in contact with children are required to complete the training and the training needs to be renewed every two years. LPA reviewed Physician's Report (LIC 701) for two children, C2 and C3. LPA observed Physician's Report for C3. Child, C2 does not have the missing Physician's Report.

Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: EAST VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430702131
VISIT DATE: 09/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During facility walk through LPA also observed signage near the kitchen sink informing staff to use drinking water gallons for washing fruits and vegetables and for food preparation purposes.

LPA cleared two citations and provided the Letter of Deficiency Citations cleared forms.

LPA also provided the e-mail address for the advocates Child Care Advocate Program: https://cdss.ca.gov/inforesources/child-care-licensing/child-care-advocates



Four (4) Type B citations were cited as a result of today's inspection.

Exit interview conducted and report was reviewed with Staff, Dora Cortez. Appeal Rights provided.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/04/2024 04:16 PM - It Cannot Be Edited


Created By: Farida Raja On 09/04/2024 at 02:09 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: EAST VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430702131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
101220(a)

1
2
3
4
5
6
7
a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director/Staff to submit a plan of correction to LPA by POC due date of 08/18/2024.
8
9
10
11
12
13
14
Based on observation, interview and record review, the licensee did not comply with the section cited above for one child, C2 which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
09/18/2024
Section Cited
HSC1596.7995(a)(1)

1
2
3
4
5
6
7
(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:
1
2
3
4
5
6
7
Director/Staff to submit a plan of correction to LPA by POC due date of 08/18/2024.
8
9
10
11
12
13
14
Based on observation, interview and record review, the licensee did not comply with the section cited above for staff, S6 which poses a potential health, safety or personal rights risk to persons in care. S6 is missing proof of immunizations for measles, pertussis and influenza.
8
9
10
11
12
13
14
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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/04/2024 04:16 PM - It Cannot Be Edited


Created By: Farida Raja On 09/04/2024 at 02:31 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: EAST VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430702131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2024
Section Cited
CCR
101212(b)

1
2
3
4
5
6
7
101212 Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director to submit an updated Designation of Facility Responsibility (LIC 308) to LPa by POC due date of 09/11/2024.
8
9
10
11
12
13
14
Based on interview and record review, LPA observed staff, Dora Cortez is designated to act in Director's absence but is not a fully qualified teacher.
8
9
10
11
12
13
14
Type B
09/18/2024
Section Cited
HSC1596.8662(b)(1)

1
2
3
4
5
6
7
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reported training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director to submit proof of completion of Mandated Reporter Training for staff, S6 to LPA by POC due date of 09/18/2024.
8
9
10
11
12
13
14
Based on record review , staff S6 does not have a current Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4