434413597-1-2-2025-07-CC-JGOS-DCJRJ7-20250102120329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413597
Report Date: 01/02/2025
Date Signed: 01/02/2025 12:03:49 PM

Document Has Been Signed on 01/02/2025 12:03 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL		FACILITY NUMBER:	434413597
ADMINISTRATOR/ DIRECTOR:	ZAYEHMOUREH, MADLEN		FACILITY TYPE:	850
ADDRESS:	400 LLEWELLYN AVENUE		TELEPHONE:	(408) 412-8823
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 70	CENSUS:	DATE:	01/02/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Site Director Madlen Zayehmoureh		TIME VISIT/ INSPECTION COMPLETED:	12:20 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 Analyst's (LPA’s), Jaime Gonzales and Jennifer “Jen” Beehler, met with Site Director, Madlen Zayehmoureh, for an unannounced Annual/Random Inspection. LPA's were granted access to the facility by Site Director, Madlen Zayehmourehr and toured both indoors and outdoors during the inspection. Upon arrival, there were 9 preschool children, two staff members present and one director. Which is compliant with the facility license capacity and ratio requirements. LPA's observed all required posting near the entrance to the facility and the hours of operation are Monday – Friday, 7:00AM-6:00PM. Site 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's reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out is completed digitally using the application, Brightwell. The last fire disaster drill was conducted on 11/24/2024, which is compliant with the six-month requirement for facilities. LPA's observed a fully charged 3A40BC fire extinguisher (last serviced: 05/08/2024). LPA's observed a functioning smoke detector and carbon monoxide detector. Continuation on page 2

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL	FACILITY NUMBER: 434413597
	VISIT DATE: 01/02/2025

NARRATIVE

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The Site Director states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. There are no weapons or firearms on the premises.

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/.

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

Indoor areas were inspected by the LPA's today and observed to be clean, orderly, and safe for the day care children. During today's inspection, LPA's observed children playing with toys in the multipurpose room with teacher supervision. Furniture is in good condition and safe for children and the floors were clean and free of tripping hazards.

Drinking water is readily available for children in the facility via water fountains and water gallons with disposable cups in each classroom. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom outside of the building, not utilized by the children. Sick children are isolated in the office until parents pick-up. There is a working telephone in the facility.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL	FACILITY NUMBER: 434413597
	VISIT DATE: 01/02/2025

NARRATIVE

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The outdoor area was inspected and observed to be fenced in. There is a playground, sandbox, play house, painting, and science area for children to engage in play with. LPA's observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (rubber tanbark) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by standing canopy structures.

The facility offers a full day program with AM/PM snacks to children. Lunch is provided by the parents. AM/PM Snack Menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use.

Five (5) children’s files and (3) staff and (1) Director files were reviewed. One staff and the director are missing Mandated Reported Training. The Site Director has current CPR/First-Aid that expires 04/06/2026. LPA's reminded that the Mandated Reporter Training must be renewed by all staff every 2 years.

During today's inspection the following documents were collected:
-LIC308 showing Erika Sanchez-Ferrer as designee.
-LIC9040 Child care facility roster
-Proof of Lead testing: 12/06/2022
-Updated Parents Handbook- with updated hours of operations
-Sign-In/Sign-out Sheet with proof that (C4) did not start school until 01/24/2024 which is in compliance with license age capacity.
-Updated personnel report LIC500

Due to todays inspection, One Type B deficiency and One technical violation was issued. More details are provided on the LIC 809-D and LIC9102 pages. Exit interview conducted and report was reviewed and provided to the Site Director Madlen Zayehmoureh along with appeal rights. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL	FACILITY NUMBER: 434413597
	VISIT DATE: 01/02/2025

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/02/2025 12:03 PM - It Cannot Be Edited

Created By: Jaime Gonzales On 01/02/2025 at 11:23 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: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL	FACILITY NUMBER: 434413597
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 files which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/13/2025
	Plan of Correction
1 2 3 4	Site Director will provide updated mandated reporter training certificates for 2 staff people.

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:

Jaime Gonzales

LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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