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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404385
Report Date: 05/28/2024
Date Signed: 05/28/2024 04:11:19 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/28/2024 04:11 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:SJB - NORTHWOOD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404385
ADMINISTRATOR/
DIRECTOR:		YASHEVA CAESARFACILITY TYPE:
850
ADDRESS:2760 TRIMBLE ROADTELEPHONE:
(408) 719-1319
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 0DATE:
05/28/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Yaheva CaesarTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 5/28/24 around 2:50pm Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced Case Management - annual continuation inspection at the facility. LPA met with the director, Yasheva Caesar and explained the purpose of today’s visit. The facility has a minimum day today and children were picked up at 1:30pm. The director stated that the facility had a minimum day on every fourth Tuesday each month.

LPA conducted an unannounced annual inspection on 5/13/24 when LPA observed an air conditioning unit without barriers at the outside of the #600. LPA advised the director to keep this A/C unit inaccessible to children in care. The site director and the compliance program manager stated that the facility would put a fence or a barrier around the A/C unit to make the unit inaccessible to children. LPA issued a Technical Assistance LIC9102 on 5/13/24.

During today’s inspection LPA observed the A/C unit was exposed at the outside of the #600 and accessible to children. The associate program director insisted over the phone that the department did not set a due date for the facility to complete screening the A/C. LPA advised the associate program director that LIC9102 was not a citation. The associate program director stated that the SJB Child Development Center has been working on finding contractors for the project but was unable to provide proof of the project progress.

A regulatory violation was observed during the inspection and a citation was issued.

Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with the director, Yasheva Caesar.
Notice of Site Visit was given and must remain posted for 30 days.
The facility refused to sign.
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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Document Has Been Signed on 05/28/2024 04:11 PM - It Cannot Be Edited


Created By: Sheena Chin On 05/28/2024 at 03:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SJB - NORTHWOOD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
06/14/2024
Section Cited
CCR
101238(a)

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(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement was not met as evidenced by :
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The director will made the A/C unit inaccessible to children and send LPA a picture of the completed project.
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Based on observation, the licensee did not comply with the section cited above. The A/C unit was exposed in the patio and accessible to children, which posed a potential health, safety or personal rights risk to persons in care. The facility refused to sign.
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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
LICENSING EVALUATOR NAME:Sheena Chin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024


LIC809 (FAS) - (06/04)
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