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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709952
Report Date: 07/20/2023
Date Signed: 07/21/2023 09:42:19 AM

Document Has Been Signed on 07/21/2023 09:42 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:HAPPY DAYS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430709952
ADMINISTRATOR:BASH, HANNA & ARIEFACILITY TYPE:
830
ADDRESS:220 BLAKE AVENUETELEPHONE:
(408) 296-5770
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
07/20/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Evelyn LlandaTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst(LPA) Anna Morales conducted a Case Management- Lead Testing/Exceedance visit and met with Acting Director Evelyn Llanda

The lead exceedance readings for sample date 8/19/2022 found Action Level Exceedance (ALE) results in outlet: R3 H- Drinking Fountain, Lead 5.5

Verification passing lead test results for the above outlet retesting on 12/28/2022 was obtained. All outlets show non-ALE results.

Type B deficiency cited and corrected during visit, exit interview conducted, and a copy of this report was reviewed with Acting Director Evelyn Llanda. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 DAYS

Gladys Kuizon
Anna Morales
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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 2
Document Has Been Signed on 07/21/2023 09:42 AM - It Cannot Be Edited


Created By: Anna Morales On 07/20/2023 at 01:58 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: HAPPY DAYS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430709952

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2023
Section Cited

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Lead Testing Written Directives 101700.3 (b)(1), a result with values 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was met as evidenced by:
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Lead testing conducted on 8/19/2022 showed ALE H Drinking Fountain in RM 3 in the facility. This posed a potential risk to 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:Gladys Kuizon
TELEPHONE:
LICENSING EVALUATOR NAME:Anna Morales
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


LIC809 (FAS) - (06/04)
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