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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408873
Report Date: 03/21/2024
Date Signed: 03/21/2024 05:18:40 PM

Document Has Been Signed on 03/21/2024 05:18 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:PASITOS SCHOOL, LLCFACILITY NUMBER:
434408873
ADMINISTRATOR:ALMA ABUNDISFACILITY TYPE:
850
ADDRESS:801 HIBISCUS LANE ROOM ATELEPHONE:
(408) 244-3551
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 24TOTAL ENROLLED CHILDREN: 28CENSUS: 16DATE:
03/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Ana GalvanTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Annual/Random inspection. LPA met with Director Ana Galvan and explained the reason for the inspection. Present during today's inspection were 16 children and at least four (4) staff. S-1 was present during today's inspection; however is not associated to facility roster. S-1's fingerprints are inactive and not associated to any other of the Licensee's facility. S-1 left during today's inspection. All other staff present have cleared criminal record and child abuse index. Director was reminded that all adults 18 and over, 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 Child Care Center. 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 also observed at 1:52PM and 3:27PM that children went to the restroom. There was no staff standing where they can visually see children.

There is an area to post required postings, such as license, notification of parent's rights, personal rights, and car seat law. The hours of operation are Monday through Friday 7:30AM to 6PM. LPA reviewed the sign in/out sheet.

LPA toured the inside and outside of the center with Director. The floors were free of tripping hazard. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. LPA reminded Director that any blades for blenders or food processors and graters need to be inaccessible to children.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873
VISIT DATE: 03/21/2024
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-----------CONTINUATION OF 809 DATED 03/21/2024 PAGE 1---------------

There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 02/14/2024. Director stated that there are no weapons, such as firearms, stored on the premise.

The outdoor activity area is fenced. LPA observed that one section of the back fence is leaning. The owner of the center has contacted the Moorland School District to fix the fence. LPA observed that there is a swing, but there is no resilient material underneath. LPA also reminded Director that all water tables need to be emptied after each use.

All meals are prepared and brought from home. The center only provides snacks to children. Drinking water is provided through individual water bottles, Brita filter, and water fountain. Snack menu was observed to be posted.

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.
The center was unable to pull lead testing forms and results.
LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records. For IMS information see PIN 22-02-CCP. 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/.

------------------CONTINUES ON 809 DATED 03/21/2024 PAGE 3--------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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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: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873
VISIT DATE: 03/21/2024
NARRATIVE
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-------------CONTINUATION OF 809 DATED 03/21/2024 PAGE 2-------------

A copy of the facility roster was obtained. Five (5) children's files were reviewed. The record reviewed include but not limited to admission agreement and immunization records.

Four staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter training. There is at least one staff with a valid CPR/1st Aid, which expires on 09/2025.

Facility will submit the following:
- Lead testing results, LIC 9275, LIC 9256, and LIC 999A which indicates the water outlets tested
- proof of completion of admin/supervision for Director
- work order to repair fence and proof that is fixed once completed
- proof of resilient material under swing
- updated waiver request to share outside area with school on campus.

As a result of this inspection, a Type A and Type B citation was issued. A civil penalty of $500 was assess for caregiver background check. Exit interview conducted and report was reviewed with Director Ana Galvan. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Director, Ana Galvan, that this report dated 03/21/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director to provide a copy of this licensing report dated 3/21/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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Page: 3 of 7
Document Has Been Signed on 03/21/2024 05:18 PM - It Cannot Be Edited


Created By: Samantha Yip On 03/21/2024 at 04:34 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: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in one out of four persons, which poses an immediate health, safety or personal rights risk to persons in care. S-1's fingerprints are inactive and not associated to facility. S-1 left during today's inspection.
POC Due Date: 03/22/2024
Plan of Correction
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By POC 03/22/2024, S-1 was complete fingerprints and understands that they cannot return until fingerprints are cleared and associated.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/21/2024 05:18 PM - It Cannot Be Edited


Created By: Samantha Yip On 03/21/2024 at 04:34 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: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Director stated that lead testing was completed, but was unable to show proof.
POC Due Date: 03/29/2024
Plan of Correction
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By POC 03/28/2024, Director will send Lead testing results, LIC 9275, LIC 9256, and LIC 999A which indicates the water outlets tested.
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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By POC 03/28/2024, facility will submit proof of purchase of resilent material and proof that was placed under the swing.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 03/21/2024 05:18 PM - It Cannot Be Edited


Created By: Samantha Yip On 03/21/2024 at 04:34 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: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. At 1:52PM and 3:27PM. LPA observed that children went to the restroom. There was no staff standing where they can visually supervise the children in the restroom.
POC Due Date: 03/29/2024
Plan of Correction
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By POC 03/28/2024, facility will submit when training will be conducted with staff. Once training is completed, director will submit meeting notes and staff who attending training to Licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


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