430710458-2-29-2024-07-CC-AMOS-D2V2P6-20240227163351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710458
Report Date: 02/27/2024
Date Signed: 02/29/2024 03:26:08 PM

Document Has Been Signed on 02/29/2024 03:26 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:	HUGHES STATE PRESCHOOL		FACILITY NUMBER:	430710458
ADMINISTRATOR:	ADRIANA SALAS		FACILITY TYPE:	850
ADDRESS:	4949 CALLE DE ESCUELA		TELEPHONE:	(408) 423-1518
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 44	CENSUS: 13	DATE:	02/27/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Joanie Nellis		TIME COMPLETED:	12:10 PM

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Licensing Program Analyst (LPA) Anna Morales conducted an REQUIRED- 3 year required inspection. The facility is located on the campus of Hughes Elementary School. The facility is located on the campus of Hughes Elementary School. LPA notes that the District Preschool is licensed in Room 25, and The State Preschool is located in Room 37. which operates a half day program from 8:15 am to 11:15am, Monday through Friday. during the calendar school year. Classroom 25 operates Mon-Friday, full day year around program. All classrooms operate under Title 22 and Title 5 (State Preschool). LPA was greeted by Site Director Joanie Nellis and one teacher with 13 children

LPA observed the 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),and Activity Schedule. Last disaster drill was conducted on 1/30/24.

In classroom 37, LPA observed 13 children engaging in activities. In Classroom 25, LPA observed six children(preschool aged children) with two staff. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. There were no bodies of water observed. There is one toilet and two sinks inside the classroom 37 and in Room 25. Director stated that facility do not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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: HUGHES STATE PRESCHOOL	FACILITY NUMBER: 430710458
	VISIT DATE: 02/27/2024

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Director stated that there is an isolation area while waiting for pick up by parents. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed play equipment were in good condition. LPA observed resilient materials under the climbing structures. Drinking water was readily available to children indoor and outdoor ( children bring there own water bottles). The elementary school cafeteria provides breakfast and snacks. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, smoke and carbon monoxide detectors were observed. They are hard wired.
This facility is providing Incidental Medical Services – IMS Plan. 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(USDO) 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/.
LPA provided the Program Director with website resources on managing food allergies at school and handling medical emergencies related to food allergies.
CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm
American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx.
LPA observed the sign in and out system in the entrance of the preschool. The facility maintains an updated roster of children enrolled in the program. A sampling of children and staff files was taken for review during today's inspection.

Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment and Immunization.

-continue on LIC809C-

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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: HUGHES STATE PRESCHOOL	FACILITY NUMBER: 430710458
	VISIT DATE: 02/27/2024

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Staff records reviewed include, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPA reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

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). LPA verified that the lead testing was completed in accordance to the Written Directives.

Director was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited today's inspection. Exit interview was conducted and reviewed with Director. Notice of site visit was given and must remain posted for 30 days.

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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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