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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404985
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:01:10 PM

Document Has Been Signed on 11/03/2022 03:01 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DAHL STATE PRESCHOOL/HEAD STARTFACILITY NUMBER:
434404985
ADMINISTRATOR:VUONG, FRANCESFACILITY TYPE:
850
ADDRESS:3200 WATER STREETTELEPHONE:
(408) 360-8904
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 23DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:RocioTIME COMPLETED:
03:30 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken. This facility is currently licensed for a capacity of 48. Licensing staff met with Director Blankenship, Rocio and explained the nature of today’s inspection. This is a preschool program that currently operates from 8AM to 4 PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 23 preschoolers and a total census of seven staff, including one Director, and six teachers or assistants present. This program is on the Captain Dahl elementary school campus.

Physical Plant: All areas identified on the Facility Sketch were inspected. This preschool program consists of the following classrooms: Room 1 & Room 2: Room 1: This classroom is also called the part day classroom, currently operates as an AM program only, from 8AM to 11 AM, no more than 4 hours per day. Per Director a PM class will be operating soon, depending on enrollment needs. LPA observed the following: Staff # 1 a fully qualified teacher with two assistants (Staff #2,3) and sixteen preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to two sinks inside the class. The two rooms are adjacent to one another, with a centralized lavatory in between.

Room 2: This classroom is also called the full day classroom This classroom currently operates as a full day classroom. Staff # 4 a fully qualified teacher with two assistants (Staff #5,6) and sixteen preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to two sinks inside the class. The two rooms are adjacent to one another, with a centralized lavatory in between.
All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient have telephone services, heating, lighting, and ventilation. 1/ 7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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General sanitization & safety: Preschoolers have their own cubby to store their belongings. Per Director, sick children are isolated in a calm area inside of each classroom in accordance to Santa Clara county Public Health guidelines. LPA advised Director that all storage containers for solid waste, including moveable trash receptacles must have tight-fitting covers that are kept on, and in standard condition, LPA advised there to be foot petals to open trash bins. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care, locked in upper cabinets. Director states that poisons are kept with the custodian. No bodies of water or other hazards were observed during inspection. Director understands that smoking is prohibited. Per Director there are no firearms on site.

Kitchen: All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Water and refrigerator temperatures in standard condition. Director states waste is to be discarded immediately after each meal. LPA has advised a deep cleaning of the refrigerator.

Food: Menus are posted on site one month in advance, in each classroom. Menus for the past one year are available upon request. Facility provides Snacks (AM/PM), breakfast and lunch. LPA reviewed food for availability, quantity and appropriateness to children in care. Per Director, all meals are prepared daily at Kidango’s head office (Freemont) and transported to facility. Facility has a food contract with Kidango. Snacks and supplemental food with 5 components kept on site. Per Director there is an allergy list for each child posted in kitchen area. LPA and director Discussed a name to face and allergy, system to be posted in kitchen area for best practice. Director states there currently no children enrolled that have allergies, one child has a cashew sensitivity. Per Director no nuts are allowed on site. No food from home is allowed. LPA has advised snacks to be placed in containers. 2/7

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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LPA and Director discussed regarding child with cashew sensitivity, to have updated information on child. Director states that child currently does not require medication for this sensitivity. Director will obtain Doctors and parents notes for any instructions on sensitivity to this and place in child’s file.

Lavatories: There are two children's lavatories, beside one another, in proximity to each classroom. There are two toilets in each, four in total, two sinks in each and four in total. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. Director states that if there is low attendance, a sick child will utilize the staffroom lavatory. When there is full attendance, the farthest toilet on either side will be used, closed until cleaned. All hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. Director states that the staffroom lavatory is in the family advocate office.

Outdoor Playground: Equipment is in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. There is a sandbox covered with a hard surface when not in use. Director states this sandbox is currently not in use, if used, it is to be inspected daily or before use. There is a locked storage in the playground, where custodial supplies are kept.



Facility Records: All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Santa Clara County office of Education, (San Jose Unified School District).
LPA did not review staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files. 3/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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LPA was able to confirm that at least one staff (Director) has record of CPR and First Aid, valid until 03/06/2023. Director has a Directors permit valid thru 11/01/2027. Per Director all staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. Per Director all staff has completed Mandated Reporter Training, Director’s training valid thru 08/11/2024. Directors understand this must be renewed every two years.

LPA was unable to review children's files or issue an LIC 857. Per Director after covid 19, files were electronic and kept with their program. LPA will review staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

Supervision: All children were observed to be under visual supervision of a teacher at all times.
Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where sign in. Facility uses an electronic sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There are no known waivers of file.

Medical & First Aid Supplies: There is a first aid kit in each classroom, kept in a fanny within a backpack. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked every month. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. Any medication is kept in a locked cabinet and/or in emergency backpack when outside (at least six feet high) which is stored out of reach of children.



Per Director there are currently no children enrolled who required Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 4/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, the fire department conducted a fire inspection on 08/17/2022. There are Fire extinguishers, size 3A40BC in each room, last serviced 08/17/2022; a last fire drill was conducted on 11/01/2022. Director understands this is to be completed every six months.

Matts and cots: Cots inspected for napping and were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped daily with a detergent, disinfectant or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and is washed on site each Friday (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding is stored on top of each cot, with a plastic mat in the middle, so as not to touch.



Lead Testing: Director states a certified external water sampler took a sample on 10/28/2022 and 10/29/2022. Per Director, results will come within the next two weeks. Director understands providers must submit the LIC 9275, a completed signed and dated childcare sampling checklist form LIC 9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self-report testing results. As a safety measure, Director has currently capped off any drinking fountains indoor and outdoor.

LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm 5/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan. LPA and Director discussed updating relocation site off premises in the event of an emergency, Director will fill out form and post on or by the end of the day.

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

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers



The following was discussed:
· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties. 6/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAHL STATE PRESCHOOL/HEAD START
FACILITY NUMBER: 434404985
VISIT DATE: 11/03/2022
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All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There are NO deficiencies being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

LPA and Director discussed the following: 1. Place food in kitchen in plastic containers. 2. Clean refrigerator. 3. Place a safety knob on door in (classroom 2). 4. Add employees to Guardian. 5. Keep staff files in binder at facility. 6. Name to face food allergy list. 7. Obtaining information on cashew sensitivity from Medical provider and parents. 8. Keep child’s files in binder at facility. 9. Update relocation site # 2. 10. Replace trash bins with foot petals. Director understands that while facility is currently in compliance, failure to take such measures may result in future citations. Director will send photos via email to LPA, this shall be complete within four weeks and understands LPA may conduct an unannounced case management to inspect the facility for updates. Director did present an email from Regional Manager (RM) Studebaker confirming electronic files are permitted, so long as there is a plan in place in the event that the system goes down #5, #8, will address this plan, in the event of a power system failure or facility is unable to access records.

A notice of site visit was issued and must remain posted for 30 consecutive days.

Exit interview conducted and report was reviewed with facility representative. 7/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7