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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709429
Report Date: 11/06/2024
Date Signed: 11/06/2024 05:27:32 PM

Document Has Been Signed on 11/06/2024 05:27 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:MCKINLEY STATE PRESCHOOL/HEAD STARTFACILITY NUMBER:
430709429
ADMINISTRATOR/
DIRECTOR:
ELVIRA CORTEZFACILITY TYPE:
850
ADDRESS:651 MACREDES AVENUETELEPHONE:
(408) 573-4716
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 61DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Renee Garcia TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPA's) Anna Morales and Kate Huang conducted a Case Management inspection to follow up on an Unusual Incident that was reported by the facility to Licensing on 11/1/24. LPA's was greeted by Renee Garcia, Supervisor of Preschool Sites, Early Learning Services. LPA's toured the facility, interviewed staff, and reviewed files.

Based on interviews and evidence gathered, it was determined that on 10/31/24, approximately at 11:30am a Preschool aged child(C1) was left unattended for approximately 1 minute in the playground outside Classroom Room 4. This poses an immediate risk to the health, safety, and personal rights to children in care.

A Type A citation was issued at today's visit, and a copy of the Facility Evaluation Report LIC809/LIC809D, has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for the next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

Exit interview was conducted with Renee Garcia, Supervisor of Preschool Sites, Early Learning Services, and Plan of Corrections were reviewed. A notice of site visit has been issued and must remain posted for 30 days. Appeal Rights Given.
Gladys KuizonTELEPHONE: (510) 566-5850
Anna MoralesTELEPHONE: (408) 334-8325
DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 11/06/2024 05:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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: MCKINLEY STATE PRESCHOOL/HEAD START

FACILITY NUMBER: 430709429

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/06/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Responsibility for Providing Care and Supervision(a)(1) 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.
Deficient Practice Statement
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POC Due Date: 11/07/2024
Plan of Correction
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Director stated that she will submit a plan to ensure that children are supervised at all times by the POC date.
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 KuizonTELEPHONE: (510) 566-5850
Anna MoralesTELEPHONE: (408) 334-8325

DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024

LIC809 (FAS) - (06/04)
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