430710485-2-12-2024-07-CC-FRAA-D2DNJC-20240212093008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710485
Report Date: 02/09/2024
Date Signed: 02/12/2024 09:30:19 AM

Document Has Been Signed on 02/12/2024 09:30 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:	EDENVALE HEAD START		FACILITY NUMBER:	430710485
ADMINISTRATOR:	LE, THUY KIM/HUYNH ALINA		FACILITY TYPE:	850
ADDRESS:	5319 CARRYBACK AVENUE		TELEPHONE:	(408) 573-4025
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	57	CENSUS: 27	DATE:	02/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Roopali Born		TIME COMPLETED:	01:35 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 02/092024 at 8:42am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Roopali Born, for an unannounced Required-3 Year inspection. The facility is licensed to serve children ages 2.9 years to 5 years in rooms 1,2 and 3. Rooms 1 and 2 were in use during today's inspection. Director stated that room 3 is not currently used as they need to change the flooring. LPA observed the room 3 to be empty. The facility has one waiver on file for electronic sign in/ out. LPA observed the required posted materials including menus, lesson plans and daily activity schedule in each classroom. Days and hours of operation are Monday through Friday, 8:00 am to 5:00 pm. Director stated that children are present at the facility from 8:15am-2:15pm. LPA and director toured the indoor and outdoor areas of the facility. LPA observed: Room 1: 3 teachers and 12 children. Room 2: 2 teachers and 15 children. Facility was in compliance with teacher to children ratio requirement. The classrooms, children's restrooms, staff restroom and kitchen were inspected. Children were having breakfast and engaged in circle time under direction from staff. Facility has central heating/cooling for comfort of children. Director states that there are no weapons including firearms on the premises. There is a working telephone at the facility 408- 573-4025 and 408-573-4026. Disinfectants and cleaning products were observed to be stored in high cabinets in the bathroom area and in locked cabinet under kitchen sink. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Napping mats were appropriate and stored with separators in between to avoid contact. LPA observed solid waste containers with tight-fitting lids in the rooms, bathrooms and kitchen area. LPA observed zoning and supervision charts in each classroom. Restrooms and sinks for children and staff bathroom were observed to be safe, sanitary, and in working condition. Director stated that staff follow a cleaning checklist in the morning and after children leave to cleans the classrooms. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EDENVALE HEAD START	FACILITY NUMBER: 430710485
	VISIT DATE: 02/09/2024

NARRATIVE

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LPA observed fire extinguishers and working smoke and carbon monoxide detectors. Director stated that these are inspected on an annual basis. LPA observed Emergency Disaster Plans in each class and first aid bags near the exit to the outside area in each classroom. Last fire drill was conducted and logged on 01/18/2024 which is within the six-month requirement for facilities.

Drinking water is readily available for children in each room through a water dispenser and disposable cups and in the outdoor playground area through water coolers and disposable cups. Water lead testing was completed for the facility on 11/18/2022 and no Action Level Exceedances were reported.

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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA obtained a copy of the water lead test report along with the LIC 9275, LIC 9276 and facility sketch indicating water outlets tested. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Food storage and preparation areas were observed to be sanitary. LPA observed foods and beverages were stored safely to prevent contamination and spoilage. Director stated that food is provided through Kidango catering and is delivered everyday and milk is delivered once a week. Facility provides breakfast and lunch to the children. LPA observed the bi-weekly menu and food restrictions/allergies list posted on the kitchen refrigerator.

Outdoor playgrounds and play equipment were inspected and observed to be fenced in and free of hazards. LPA observed an area at the back left side which was cordoned off and director stated that a tree fell during the previous week's storm and they had to cut down. LPA observed play equipment was in good condition, age-appropriate, and has rubber flooring under play structures to absorb falls. Shaded rest area is provided by trees. LPA observed two locked storage sheds. There were no bodies of water observed. Director stated that the second playground located in front of the office is not it use at present and will be used by Room 3 when reopened.

Continued on Page 3

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EDENVALE HEAD START	FACILITY NUMBER: 430710485
	VISIT DATE: 02/09/2024

NARRATIVE

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Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed eight (8) children's files during today's inspection. Each child's file reviewed contained the required forms.

LPA reviewed four (4) staff files including director's. LPA obtained a copy of director packet for Roopali Born during today's inspection. All staff files reviewed contain the required transcripts/verification of experience. Staff had valid pediatric CPR/First Aid certification. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required immunization's against pertussis, measles and influenza. LPA observed the required Mandated Reporter Training on file for all staff.

The program is operated by the Santa Clara County Office of Education and all criminal background checks for staff are handled by the Department of Education and thus do not come under the jurisdiction of Community Care Licensing Division.

Director stated that facility does handle medications but currently has no children in care who require Incidental Medical Services (IMS). LPA observed medication storage cabinets which are inaccessible to children. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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-care-centers/.

Isolation of sick child was discussed, and Director stated that sick children will be isolated in the quiet area of the classroom or director's office and a separate bathroom located in the office can be used which is off limits to other children. Child is always under visual supervision while in care of the facility.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: EDENVALE HEAD START	FACILITY NUMBER: 430710485
	VISIT DATE: 02/09/2024

NARRATIVE

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LPA obtained a copy of the updated Emergency Disaster Plan (LIC 610) and Personnel Report (LIC 500) during today's inspection. Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. 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.

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

One Type B deficiency was cited today on the attached LIC 809D page. Appeal rights were printed and provided to Licensee. Exit interview conducted and report was reviewed with the Director, Roopali Born.

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

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/12/2024 09:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: EDENVALE HEAD START	FACILITY NUMBER: 430710485
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(b)

Reporting Requirements

(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensing department was not notified of a change in child care center director within 10 days. Director stated that she started as director in 08/2023.
	POC Due Date: 02/23/2024
	Plan of Correction
1 2 3 4	LPA obtained director packet during today's inspection. Deficiency was cleared during today's inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC809 (FAS) - (06/04)

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