434412705-3-7-2024-07-CC-SYIP-D35W3F-20240307155551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412705
Report Date: 03/07/2024
Date Signed: 03/07/2024 05:31:20 PM

Document Has Been Signed on 03/07/2024 05:31 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:	QUEEN OF APOSTLES SCHOOL		FACILITY NUMBER:	434412705
ADMINISTRATOR:	PAUL, SOPHIA		FACILITY TYPE:	850
ADDRESS:	4950 MITTY WAY		TELEPHONE:	(408) 252-3659
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 9	CENSUS: 5	DATE:	03/07/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:48 PM
MET WITH:	Sophia Paul		TIME COMPLETED:	04:05 PM

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 Analysts (LPAs) Samantha Yip and Andrea Cortez conducted an unannounced Required- 3 Year inspection. LPAs met with Director Sophia Paul and explained the reason for the inspection. Center is located on the Queen of Apostles School campus. Present during today's inspection were five (5) children and at least two staff. Facility was within ratio during today's inspection. There is area to post required postings, such as license, notification of parent's rights, and personal's rights. The hours of operation are Monday through Friday 7AM to 6PM. LPA reviewed sign in/out. The center has a waiver for their sign in/out. LPAs toured the inside and outside of the center. Disinfectant, cleaning supplies, and other items that could pose a risk to children in care were inaccessible. There are toys and equipment for children. Floors were free of tripping hazard. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 10/26/2023. There are no weapons, such as firearms, stored on the premise. The outside area is fenced. LPA reminded Director to ensure that gate is closed when children are outside. There is waiver for the center to share the outside area with the school on campus. Areas around play structure have resilient material. LPAs observed that the tan bark is low. There were no bodies of water observed during today's inspection. LPA discussed with Director about checking for cracks on the slides or play structure and checking the wooden picnic table for splinters. -----------------CONTINUES ON 809 DATED 03/07/2023 PAGE 2---------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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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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: QUEEN OF APOSTLES SCHOOL	FACILITY NUMBER: 434412705
	VISIT DATE: 03/07/2024

NARRATIVE

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---------------CONTINUATION OF 809 DATED 03/07/2024 PAGE 1--------------

All meals and snacks are prepared and brought from home. Drinking water is provided through individual water bottles and use the sink to refill water bottles.

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.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) 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/.

A copy of the facility roster was obtained during today's inspection. Nine (9) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and immunization records. LPA observed that the admission agreement is missing basic services, available optional services, Rights of Department perform the duties authorized in Sections 101200(b) and (c), and Modification conditions. Director stated that she will make an addendum and send a copy to Licensing.
-----------------CONTINUES ON 809 DATED 03/07/2024 PAGE 3-------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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: QUEEN OF APOSTLES SCHOOL	FACILITY NUMBER: 434412705
	VISIT DATE: 03/07/2024

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---------------CONTINUATION OF 809 DATED 03/07/2024 PAGE 2-------------

Two staff files were reviewed. The records reviewed include but not limited to education credit and Mandated Reporter training. LPA discussed with Director that the Mandated Reporter training needs to completed either through the mandatedreporterca.com website or through one of the approved vendors. Both staff present have valid CPR/1st Aid, which expires on 09/2025.

All staff present have cleared criminal record and child abuse index. Facility representative 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.

Director will submit the following:
- Mandated Reporter training for A-1
- addendum to the admission agreement
- proof of additional resilient material
- picnic bench is either sanded down or inaccessible to children

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Director Sophia Paul. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/07/2024 05:31 PM - It Cannot Be Edited

Created By: Samantha Yip On 03/07/2024 at 03:31 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: QUEEN OF APOSTLES SCHOOL	FACILITY NUMBER: 434412705
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	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. LPAs observed that tan bark is low.
	POC Due Date: 03/14/2024
	Plan of Correction
1 2 3 4	By POC 03/14/2024, facility submit proof of purchase of additional tan bark and proof once it is installed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC809 (FAS) - (06/04)

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