430710319-6-23-2026-07-CC-JBER-DVBQJ4-20260623121207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710319
Report Date: 06/23/2026
Date Signed: 06/23/2026 12:12:27 PM

Document Has Been Signed on 06/23/2026 12:12 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:	CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE		FACILITY NUMBER:	430710319
ADMINISTRATOR/ DIRECTOR:	RACHEL SAYRE		FACILITY TYPE:	840
ADDRESS:	5303 CARTER AVENUE		TELEPHONE:	(408) 265-3580
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 27	CENSUS: 20	DATE:	06/23/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Dina Aiby - Acting Director		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	On 06/23/2026, Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Case Management/Incident inspection. LPA was greeted by the Acting Director Dina Abiy and was provided access to the facility. LPA stated the reason for the inspection was due to the self reported incident that occurred on 06/12/2026. LPA conducted a tour of the facility and collected the census. There were 20 school age children and three staff (2 Teachers/ 1 Director) present, which is compliant with ratio and capacity requirements. LPA interviewed staff, observed the facility and collected relevant documentation. It was revealed through witness testimony and documentation that Staff #1 (S1) and Staff #2 (S2) lead day care children in the summer camp to the Almaden Valley Athletic Club (AVAC) during the scheduled pool time. Children were lined up and walked over to AVAC which shares a parking lot with the facility. There were 12 children present. Staff present did not realize it, but child #1 (C1) did not wear shoes when crossing the parking lot. C1 complained of sore feet to S1 after the lifeguard instructions were completed. S1 believed the soreness was due to the few minutes children are lined up by the lifeguards near the pool and instructed on pool rules and regulations prior to entering the pool. S1 stated it was a hot and sunny day and the cement around the pool was hot where children are required to remove their shoes. Local records show temperatures peaked on 06/12/2026 at 2:53 PM at 99 degrees Fahrenheit on that day. S1 stated the cement around the pool was hot that day and even a few moments during instruction was slightly uncomfortable. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Adam Hamer
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE	FACILITY NUMBER: 430710319
	VISIT DATE: 06/23/2026

NARRATIVE

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S1 stated C1 stayed in the pool the entire time the camp was at AVAC. S1 stated when it was time to leave AVAC he asked C1 to exit the pool and C1 explained that C1 did not wear shoes to the pool. S1 inspected C1's feet and observed white blisters beginning to form on the bottom. S1 placed C1 into a wagon and pulled C1 back to the classroom.

S3 observed C1's wounds and immediately applied ice to the bottom of the feet and called C1's parents. S3 also contacted the Director Rachel Sayer. Rachel advised staff to soak C1's feet in cold water. S1 and S3 set up C1 with a cooler filled with cold water and some ice to keep the temperature down. C1 rested with feet in cold water for 30 minutes until C1's parent arrived.

C1 was taken to urgent care and C1's parents informed the facility that C1 sustained second degree burns on both feet. C1's parents reached out on 06/15/2026 to S3 and informed the facility that C1 was well enough to attend the next summer camp that C1 was enrolled in and that the Doctor stated the efforts of staff when they became aware of the injury minimized the damage.

Director Rachel Sayer and Acting Director Dina Abiy conducted training with staff regarding detailed supervision. Staff were instructed to visually supervise children's apparel, making sure they are wearing shoes, have applied sunscreen and any other necessary condition that would ensure children are safe and secure during activities.

As a result of today's inspection, no deficiencies are cited. Exit interview conducted with Acting Director. Report was reviewed and provided to the Acting Director Dina Abiy along with appeal rights.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

NAME OF LICENSING PROGRAM MANAGER: Adam Hamer
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026

LIC809 (FAS) - (06/04)

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