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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709586
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:14:47 PM

Document Has Been Signed on 01/07/2025 04:14 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:YMCA-HACIENDA VALLEY VIEWFACILITY NUMBER:
430709586
ADMINISTRATOR/
DIRECTOR:		QUE-HEATH,ROYFACILITY TYPE:
840
ADDRESS:1290 KIMBERLY DRIVETELEPHONE:
(408) 978-1156
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: DATE:
01/07/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:Roy Que-Heath & Audrey VossTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced required 1 year inspection. Upon arrival, LPA was greeted by Director Roy Que-Heath and advised he was in ratio, but would call Administrator Audrey Voss to assist in conducting the inspection. LPA advised the reason for the visit was an Annual inspection.

Director and LPA toured the inside and outside of the facility. There were 58 school age children in care with 5 staff persons present with is compliant with the license ratio and capacity. LPA observed a 3A40BC fire extinguisher last serviced 01/03/2025 which is compliant with state fire marshal regulations. LPA observed a working smoke detector and fully functioning CO2 detector in both classrooms.

LPA observed snack time. Director stated food was a grain with fruit/vegetable. The weekly menu was posted on the board near the entrance along with all required postings, including parent's rights and the facility license. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The program operates Monday-Friday, 7am-9am and afternoon session 3pm-6pm.

Due to today's inspection no deficiencies were cited. Exit interview conducted with Administrator Audrey Voss along with the report reviewed and provided. NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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