434408045-8-17-2023-07-CC-PHEZ-CUSNX7-20230817105039

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408045
Report Date: 08/17/2023
Date Signed: 08/17/2023 10:50:46 AM

Document Has Been Signed on 08/17/2023 10:50 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:	PARK AVENUE PRESCHOOL		FACILITY NUMBER:	434408045
ADMINISTRATOR:	OPHELIA IMPERIAL		FACILITY TYPE:	850
ADDRESS:	1080 THE ALAMEDA		TELEPHONE:	(408) 294-4807
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 43	TOTAL ENROLLED CHILDREN: 9	CENSUS: 6	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Ophelia Imperial		TIME COMPLETED:	11:15 AM

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	Licensing Program Analyst (LPA), Pete Hernandez, conducted a Required 1 Year inspection. LPA met with new Director Ophillia Imperial. LPA observed all the required posted materials. Head Teacher's CPR/1st Aid is current and expires 4/10/2024. There were 1 Teacher besides the Director and 6 children observed. 6 children's files were reviewed. All required documents were present in the files. Ophelia Imperial plus one Teacher; Teacher/adult-child ratio was in compliance. LPA reviewed the sign in/out sheets. Drinking water indoor is available at all times. Snack provided; current menu was observed. There is a kitchen at the facility for food preparation and is equipped with refrigerator, stove, dishwasher, microwave, and a sink with hot and cold running water. LPA observed trash cans with tight fitting covers for the disposal of solid waste. Children's bathrooms are sanitary and operable. There is a custodian for the facility that cleans the school one evening a week. Licensee states that there are no weapons on the premises. Facility has operating fire extinguishers, smoke alarms, carbon monoxide detectors with fire pull stations. Licensee provided a copy of the children's roster to the LPA. Normal operating hours are Monday through Friday 7:30AM to 5:30PM. The playground is surrounded with appropriate fencing. Shade is provided by covering at two locations and building overhang. LPA observed resilient material under the climbing structures. LPA did not observe any bodies of water. 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), Menu, and Activity Schedule. The facility has one waiver on file for electronic sign in/ out. Ophilia Imperial provided a copy of the fire drill record with last entry dated 7/23/2023. The sign in and out records and the children's roster were provided to the LPA. LPA reviewed (6) Ten children's files. Each child's file reviewed contains the required information. LPA reviewed 2 staff files. The required Mandated Reporter Training (AB1207) and the required immunization's against Pertussis, Measles, and Influenza (or opt out letter). There is at least one teaching staff member that has current CPR and First Aid certifications on file. 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). There were 6 preschool children present during today’s inspection. However, Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 8/17/2023:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: PARK AVENUE PRESCHOOL	FACILITY NUMBER: 434408045
	VISIT DATE: 08/17/2023

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/17/2023):

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPS/s discussed the requirements of AB 633 with the Licensee/Director Ophelia Imperial and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee/Director understands the requirements. Upon receipt, Licensee/Director Ophelia Imperial shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

Exit interview conducted and report was reviewed with the Licensee, Ophelia Imperial.

NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: PARK AVENUE PRESCHOOL	FACILITY NUMBER: 434408045
	VISIT DATE: 08/17/2023

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/17/23):
LPA reminded the Director was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA observed that the room is clean and safe for all children and staff. Katherine states that the schools custodial team cleans the preschool rooms Monday through Friday in the evenings during the school year. Drinking water is readily available for the children inside via two water fountains and outside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classrooms. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Licensee states that there are no weapons or firearms on the premises.

The Preschool provides AM and PM snacks and though most of the children bring their lunch from home, the school does offer a hot lunch, from the on site school cafeteria, upon request by the parent. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any medications at the Facility are stored in the Directors office. LPA observed a Fire Drill log with the last fire drill being conducted on 7/23/2023.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The resilient shock absorbent materials in the outdoor playground area are sufficient. LPA did not observe any bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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