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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414441
Report Date: 06/02/2025
Date Signed: 06/02/2025 03:18:36 PM

Document Has Been Signed on 06/02/2025 03:18 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:EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PSFACILITY NUMBER:
434414441
ADMINISTRATOR/
DIRECTOR:		CORTEZ, ELVIRAFACILITY TYPE:
850
ADDRESS:1399 SANTEE DRIVETELEPHONE:
(408) 573-4823
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 181TOTAL ENROLLED CHILDREN: 127CENSUS: 102DATE:
06/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Josephine DalitTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Syeda Bahar and Mandeep Kaur met with Director, Josephine Dalit for an unannounced case management investigation. Purpose of today's investigation: discuss one incident report that the Facility self-reported to the Department on May 28, 2025. LPAs toured the outdoor areas of the facility during today's investigation.

During today's investigation, LPAs interviewed Director.

Director states that the incident occurred on May 28, 2025, around 11:35 AM. Director self-admitted that a child (C1) was found in the outdoor playarea, sitting on a table, by a Substitute Teacher (S4) who was in Room Maple 4. Director states that six children were present in the play area with Staff (S1 and S3). Staff (S3) took three children inside the classroom, Madrone 1. Director states that according to Staff (S2), Staff (S1), walked into Vlass Room Madrone 1 with two children. Director states that a child (C1) was left unsupervised in the play area for a few seconds and child (C1) must have been hiding behind the small storage rooms. Director states that staff (S4) brought the child(C1) to Class Room Madrone 1 and child(C1) was doing fine.



Director states that training was conducted on 05/28/2025 with Staff (S1, S2, S3,S5,S6 and S7)). Director states that staff (S1,S2,S3 and S5) has been provided with verbal and formal written reminder via email regarding supervision of the children.


**Continue on 809-C**
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/02/2025 03:18 PM - It Cannot Be Edited


Created By: Syeda Bahar On 06/02/2025 at 02:19 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: EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PS
FACILITY NUMBER: 434414441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2025
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.
This requirement was not met as evidenced by:
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By plan of correction due date, 06/16/2025, Licensee will submit the training material of conducting the training with all staff of the facility and the copy of the attendance sheet of all the attendees, to the department.
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Based on interviews and records review, the child (C1) was left unsupervised in the play area and brought back to the room, Madrone 1 by Staff (S4), which poses a potential Health, Safety, or Personal Rights risk to persons 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.
Belinda Devall
NAME OF LICENSING PROGRAM MANAGER:
Syeda Bahar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2025


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: EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PS
FACILITY NUMBER: 434414441
VISIT DATE: 06/02/2025
NARRATIVE
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Copy of the children's roster, personnel report and Copies of training materials that was conducted with Staff( (S1,S2,S3,S5, S6 and S7)) were obtained during today's investigation. Copy of the email of the formal reminder of supervision to staff(S1,S2,S3,and S5) is emailed to LPA Bahar during today's investigation.

LPAs observed two small storage rooms in the playarea are being removed during today's investigation. LPAs observed three gates that are in the play area opened towards a big gate of the facility, that leads to second big gate of the facility and to the parking lot. Child was not able to get out of any of the gates. As a result of this investigation, LPAs conclude that a child (C1) was left unsupervised in the play area. Therefore, one "Type B deficiency is issued during today's investigation on the attached 809-D.

Exit interview conducted and report was reviewed with Director, Josephine Dalit. Appeal rights was provided.

A notice of site visit has been issued and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025
LIC809 (FAS) - (06/04)
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