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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413114
Report Date: 03/06/2025
Date Signed: 03/06/2025 11:04:55 AM

Document Has Been Signed on 03/06/2025 11:04 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:WILLOWS NURSERY SCHOOL, THEFACILITY NUMBER:
434413114
ADMINISTRATOR/
DIRECTOR:		ARIAS CHAVEZ, LEYDIFACILITY TYPE:
850
ADDRESS:1149 MINNESOTA AVENUETELEPHONE:
(408) 352-5601
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 17TOTAL ENROLLED CHILDREN: 17CENSUS: DATE:
03/06/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Director Leydi Arias ChavezTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennifer "Jen" Beehler and Marilou Monico conducted an unannounced Case Management - licensee Initiated inspection. Upon arrival, LPAs were greeted by Director Leydi Arias Chavez and provided access to the facility. LPAs stated the reason for the visit was to measure for the capacity increase request.

The interior space measured as follows:

Classroom 16.58 X 16.08 = 183.70
Play Area 11.50 X 9.92 = 114.08
Building Area 11.67 x 12.17 = 153.69
Kitchen Area 13.08 x 9.50 = 124.26 - 18.2 (encumbered space) = 106.06
TOTAL: 557.53 / 35 Sq.Ft. = 16 Children

The total outdoor space is 4,415.173 / 75 Sq.Ft. = 58 Children. This was measured on 11/08/2012 and remains the same. The facility had 2 toilets and 2 sinks available for children in care. There is one adult bathroom. The fire clearance was approved for 22 children on 02/18/2025. This report will be reviewed by Community Care Licensing Management to determine capacity limits.

LPAs observed two children without teacher supervision near the play stage located in the outdoor play area. LPAs observed a teacher taking a child to the toilet, while the other teacher was in the back yard with a group of children. The second teacher did not have visual sight of the children near the play stage where she was stationed in the backyard. She could see the three children that were at the table having a snack. LPAs reminded the Director of the requirement that children require 100% visual supervision at all times.

Due to today's inspection, 1 Type B deficiency was cited, more details provided on the attached LIC809-D. Exit interview conducted with Director, Leydi Arias Chavez, report reviewed and provided along with appeals rights. NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 03/06/2025 11:04 AM - It Cannot Be Edited


Created By: Jennifer Beehler On 03/06/2025 at 10:36 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: WILLOWS NURSERY SCHOOL, THE
FACILITY NUMBER: 434413114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2025
Section Cited
CCR
101229(a)(1)

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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.
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Director to create a plan to address the requirement of 100% visual supervision for children in care. Director will provide copy of the plan to LPAs by Monday 03/10/2025.
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This requirement was not met as evidenced by: LPAs observed lack of visual supervision for 2 children in the play stage located in the outdoor play area. This poses a potential health and safety risk to 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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