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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404301
Report Date: 04/27/2023
Date Signed: 04/28/2023 08:20:24 AM

Document Has Been Signed on 04/28/2023 08:20 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:ASSOCIATED STUDENTS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404301
ADMINISTRATOR:HEATHER VISEFACILITY TYPE:
850
ADDRESS:460 SOUTH EIGHTH STREETTELEPHONE:
(408) 924-6988
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 40DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jane ZamoraTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) conducted an ANNUAL REQUIRED INSPECTION and was greeted by Director Jane Zamora. The Centers hours of operation are Monday-Friday, 7:30-5:15pm. 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), Menus, and Activity Schedule. LPA observed a current Children's roster. Last disaster drill was conducted on 3/31/2023

There are four classrooms inside the center:
1. Classroom- Galaxy- 11 Preschool aged children, One qualified teacher and two teacher's assistants
2. Classroom Two is not being used at this time.
3. Dandelion - 13 preschool aged children, One qualified Teacher and one teacher assistant.
4. Splash- 16, One Qualified teacher and one teachers assistant.
Facility was observed to be in compliance with teacher to child ratio requirement during visit.

LPA observed fully charged Fire extinguishers in the hallways next the classrooms, The Carbon monoxide detectors are interconnected with the smoke alarms located on the ceilings. Disinfectants and toxic materials are stored inaccessible to the children. Observed trash bins with tight fitted lids. LPA observed fully fenced playground area. Observed climbing structures and with materials that observe falls. Shade is provided by the patio cover. The children use there own water bottles, and the water is also provided by the school. Playground is age appropriate.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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: ASSOCIATED STUDENTS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404301
VISIT DATE: 04/27/2023
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Observed the sign and sign out procedure. The isolation room is in the main office. This facility is providing Incidental Medical Services – IMS Plan. Reviewed medication and supporting documentation.

LPA reviewed a random selection of children files. Children records reviewed include , Identification, Medical Assessment, Consent for Medical Treatment and Immunization

LPA reviewed a random selection of Staff records reviewed include Health Screening Report and TB test, and Immunization (Measles, Pertussis, and Flu) record and current Mandated Reporter Training. LPA reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. Staff have current certification in Pediatric CPR and First Aid.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPA discussed the requirements of AB 633 with the Director. The Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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: ASSOCIATED STUDENTS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404301
VISIT DATE: 04/27/2023
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No Deficiencies are being cited based on the LPA's observations.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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


NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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