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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410829
Report Date: 03/27/2024
Date Signed: 03/27/2024 11:43:59 AM

Document Has Been Signed on 03/27/2024 11:43 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAN JOSE CHRISTIAN PRESCHOOLFACILITY NUMBER:
434410829
ADMINISTRATOR:ASHLEY KOEPPLINFACILITY TYPE:
850
ADDRESS:1300 SHEFFIELD AVENUETELEPHONE:
(408) 371-7741
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 84TOTAL ENROLLED CHILDREN: 55CENSUS: 44DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Rochelle LeggettTIME COMPLETED:
11:53 AM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Farida Raja, met with Site Director, Rochelle Leggett, and explained purpose of visit. Upon arrival, LPAs were admitted into the facility by office staff.

There was an injury that occurred to a child in care that required physician follow-up and the facility did not report the injury to the Department. The Site Director acknowledged that she was aware of the follow-up for the child, regarding a visit to the physician to have the injury assessed.

LPAs reminded the Site Director of the requirement to report injuries to children that require medical care, such as a physicians care, to the Department within 24 hours. A written report (LIC624) shall additionally be submitted to the Department within seven (7) days of the initial report being made. LPAs additionally advised reviewing CA Code of Regulations Section 101212 Reporting Requirements for all additional incidents that may require reporting to the Department.

LPAs additionally observed that one staff member did not have her mandated reporter training renewed and advised that it shall be completed every two years per the requirements of AB1207. LPAs provided website of www.mandatedreporterca.com to complete the training again and advised reviewing all staff files for completion.

As a result of today's inspection, deficiencies were cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Site Director, Rochelle Leggett.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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 03/27/2024 11:43 AM - It Cannot Be Edited


Created By: Cortney Nelson On 03/27/2024 at 10:40 AM
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: SAN JOSE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 434410829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
101212(d)(1)(B)

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101212 Reporting Requirements (d) Upon the occurrence... a report shall be made to the Department by telephone or fax within the Department's next working day.. In addition, a written report containing the information specified... shall be submitted... within seven days... (1) Events reported shall include... (B) Any injury... that requires medical treatment.

This requirement was not met as evidenced by:
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The Site Director shall submit the written report (LIC624) for the child's injury to the Department by 3/29/2024. LPAs advised the LIC624 may be emailed or faxed to the Department once completed.
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The Licensee did not submit a written report or make an initial report within 24 hours for an injury that occurred to a child that required medical treated, which poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
04/08/2024
Section Cited
HSC1596.8662(b)(1)

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1596.8662 (b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training.. and shall complete renewal mandated reporter training every two years...

This requirement was not met as evidenced by:
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The Site Director shall submit mandated reporter training certificate for one staff member by 4/8/2024.
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The Licensee did not ensure that all staff members completed their mandated reporter training as one staff members expired in 2023, which poses a potential risk to the health, safety, and personal rights of children in care.
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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:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


LIC809 (FAS) - (06/04)
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