434414146-2-2-2023-07-CC-PHEZ-CNNSDJ-20230202124712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414146
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:47:19 PM

Document Has Been Signed on 02/02/2023 12:47 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LYNHAVEN PRESCHOOL		FACILITY NUMBER:	434414146
ADMINISTRATOR:	HEATHER ELSTON		FACILITY TYPE:	850
ADDRESS:	881 SOUTH CYPRESS		TELEPHONE:	(408) 341-7127
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 22	CENSUS: 18	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sherry Gallab		TIME COMPLETED:	01:24 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	On 2/2/2023: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Required 1 Year Annual inspection of Llynhaven Preschool. The Preschool is located on the premises of Lynhaven Elementry School which is part of the Cupertino Unified School District. The program is approved for rooms 44 and 45 for the children in care, but currently only uses room 44 for normal activities. LPA met with Director Sherry Gallab, and explained the purpose of today's visit. Facility’s License, Emergency Disaster Plan, snack menu, Parents’ Rights Poster PUB393, Personal Rights, and Activity Schedules, were observed to be posted. Facility's operating days and hours are Monday through Friday 8:15am to 4:15pm. Room 44: 1 Teacher, 2 Assistants and 18 Children. Facility was in compliance with teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers and assistants. The physical plant was inspected. LPA toured the building with the Director. Indoor space: The classrooms, restrooms were inspected. The Director was present during inspection the LPA did not observe disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children. All other cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on in rooms used for eating. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a 3A40BC Fire extinguisher, working hard wired Smoke and Carbon Monoxide Detectors. Log shows that the last Fire Drill was conducted on 2/1/23. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LYNHAVEN PRESCHOOL	FACILITY NUMBER: 434414146
	VISIT DATE: 02/02/2023

NARRATIVE

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CONTINUATION OF PAGE 1 809C REPORT DATED 1/31/2023:

Outdoor Space: Outdoor playgrounds were inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of 10 Children's files and 3 Staff files were taken for review. All child files contained immunization's, Physician's and Parent's Health Report. Staff files contained appropriate educational units. There was at least 1 Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Director Gallab's expires on 1/2025. Children's Roster was reviewed and a copy was provided to the LPA.

Director stated that facility does handle medications and currently do have children in care who require Incidental Medical Services. Facility has an approved IMS Plan on file with San Jose Regional Office. Isolation of sick child was discussed, and Director explained that a sick child is brought to the office area to be isolated from other children. Child is always under visual supervision while being cared for.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LYNHAVEN PRESCHOOL	FACILITY NUMBER: 434414146
	VISIT DATE: 02/02/2023

NARRATIVE

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CONTINUATION OF PAGE 2 809C REPORT DATED 1/02/2023:

All the staff had current Mandated Reporter Certificates on file.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted a copy of this report was discussed and left with the Licensee, Sherry Gallab, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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