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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710093
Report Date: 05/28/2024
Date Signed: 05/28/2024 12:15:15 PM

Document Has Been Signed on 05/28/2024 12:15 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 STARTFACILITY NUMBER:
430710093
ADMINISTRATOR/
DIRECTOR:
ELISA HERNANDEZFACILITY TYPE:
850
ADDRESS:13901 NORDYKE DRIVETELEPHONE:
(408) 258-1523
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 18DATE:
05/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Elisa HernandezTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 5/28/24 LPA Sheena Chin conducted an unannounced Case Management - Incident inspection to the facility in response to an incident that occurred on 5/14/2024. LPA met with the director, Elisa Hernandez and explained the purpose of the visit.

The director reported on 5/16/24 that the facility observed rusts in the can of peaches and 6 children ate the peaches. The director reported the family services had contacted the Santa Clara County Public Health Department for directions.

During today’s inspection LPA interviewed staff, who stated that the expiration date for the canned peaches served on 5/14/24 was April 2024. The staff stated that the expiration date was covered by a label. The director stated that the nutritionist has expressed concerns about the expiration date to the food company, who then stated that they would make a note not to cover the expiration date with labels. The director stated that Santa Clara County Pulbic Health Department told the family health supervisor that this incident shouldn’t be a problem so the facility didn’t notify parents about the incident. The director stated that no children reported stomachache after the incident. The director stated that the facility would have a CACFP safety food review training, with staff this week to review safety protocol about handling food.

LPA observed that there were one warmer and a refrigerator in the kitchen area. The director stated the warmer was to keep lunches warm because lunches were delivered in the morning. The director stated that breakfasts, which were delivered one day before, were put in the refrigerator.

No regulatory violations were observed during today’s inspection.

Exit interview was conducted, and the report was reviewed with the director, Elisa Hernandez.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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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