430710093-4-30-2024-07-CC-SCHN-D4TVF7-20240430162329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710093
Report Date: 04/25/2024
Date Signed: 04/30/2024 04:23:38 PM

Document Has Been Signed on 04/30/2024 04:23 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:	LYNDALE HEAD START		FACILITY NUMBER:	430710093
ADMINISTRATOR/ DIRECTOR:	ELISA HERNANDEZ		FACILITY TYPE:	850
ADDRESS:	13901 NORDYKE DRIVE		TELEPHONE:	(408) 258-1523
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 13	DATE:	04/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Gladys Eng		TIME VISIT/ INSPECTION COMPLETED:	12:30 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	Page 1. On 4/25/24 around 9:20am Licensing Program Analyst (LPA), Sheena Chin, conducted an unannounced annual inspection of the center. The director was off for the entire week. The staff contacted the other director, Gladys Eng, from another site to cover this facility. Around 9:55am LPA met with Ms. Eng and explained the purpose of the visit. The Facility is licensed to serve age 2.9 to 5 years old children. Hours of operation: 7:45 AM to 4:45 PM Monday to Friday. Ms. Eng stated that the facility had two classrooms: room 1 (from 8am to 2pm) and room 2, currently empty. Ms. Eng stated that the facility followed the school district’s calendar and that the facility had winter, spring and summer breaks. Ms. Eng stated that the facility did not have weapons on the premises, that smoking was not allowed on the premises and that the facility provided Incidental Medical Services – IMS to children in need. Observation LPAs toured the indoor and outdoor areas of the Facility with Ms. Eng. Required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule were observed. The facility had fire inspection 7/3/23. LPA observed fully charged Fire Extinguishers, functioning smoke/carbon monoxide detectors, First Aid Kit, central heating, and air conditioning in all rooms. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Restrooms for children to use were observed to be in operating condition. Play equipment were maintained in a good condition, free of hazards. continue to page 2.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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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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: LYNDALE HEAD START	FACILITY NUMBER: 430710093
	VISIT DATE: 04/25/2024

NARRATIVE

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Observation
The facility provides two meals, Breakfast and Lunch. Meals are prepared, packaged and delivered by outside vendor. Trash cans for solid waste had tight-fitting covers on.

The teacher/child ratio was in compliance during today's inspection. 13 children with two teachers and an aid in room 1. The director stated that she understands the conditions, limitations, and capacity specifications of the Facility license and that children shall be always supervised within the classroom and in the playground areas.

The playground area was surrounded by appropriate fencing. Shade was provided by two canopies in the playground area. The outdoor equipment is age-appropriate and in good condition. There was a climbing structure in the playground that is age appropriate. Rubber surfacing and grass were used as resilient material throughout the playground. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed.

Records review
Disaster drills shall be conducted at least every six months and be maintained for at least one year. The last drills were conducted on 3/1/24 .

LPA reviewed facility's sign in/out procedure and record. A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization. Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA advised the director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA's inspection.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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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: LYNDALE HEAD START	FACILITY NUMBER: 430710093
	VISIT DATE: 04/25/2024

NARRATIVE

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Records review
LPA advised the director that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

On 11/14/22, the facility had water lead test result as ND but this information was not found in the Water Board system. LPA advised Ms. Eng to have the site director contact the testing vendor to upload the information to Water Board.

Discussion
Water lead test: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). All centers need to complete the lead testing in accordance to the Written Directives outlined in PIN 21-21.1.CCP. LPA referred the director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1.CCP.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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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: LYNDALE HEAD START	FACILITY NUMBER: 430710093
	VISIT DATE: 04/25/2024

NARRATIVE

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Incidental Medical Services (IMS): This facility provides Incidental Medical Services – IMS, but per Director, currently the facility does not have any children in care who requires IMS. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Deficiency
No regulatory violations were observed during today’s inspections.

Further questions
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit
Notice of Site Visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Ms. Gladys Eng, the director from another site.
The inspection reports were unable to print out due to technical difficulties. LPA Sheena Chin will email Ms. Eng the reports.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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