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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414441
Report Date: 07/08/2022
Date Signed: 07/08/2022 09:54:24 AM

Document Has Been Signed on 07/08/2022 09:54 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PSFACILITY NUMBER:
434414441
ADMINISTRATOR:MY NGUYEN-SOYFACILITY TYPE:
850
ADDRESS:1399 SANTEE DRIVETELEPHONE:
(408) 573-3340
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 173TOTAL ENROLLED CHILDREN: 173CENSUS: 78DATE:
07/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:My Nguyen-SoyTIME COMPLETED:
10:10 AM
NARRATIVE
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Licensing Program Analyst (LPA), Janette Cruz, met with My Nguyen-Soy, Director, for an unannounced case management inspection in response to a self-reported Unusual Incident that was reported to the Department on 05/09/22. Today's visit is a follow-up to LPA's previous case management visit to the Facility on 05/12/22. LPA observed 78 children and 24 teachers in the eight classrooms open.

LPA conducted additional interviews pertinent to this case management inspection. LPA also reviewed staff and children's records on facility file.

Based on the available information, a Type “A” deficiency regarding Personal Rights is being cited. See 809-D page.

A Notice of Site Visit was issued along with the Type "A" citation, and both notices must be posted near facility entrance and must remain posted for 30 consecutive days.

Exit interview was conducted and appeal rights were provided to Director, My Nguyen-Soy.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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 07/08/2022 09:54 AM - It Cannot Be Edited


Created By: Janette Cruz On 07/08/2022 at 09:10 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: EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PS
FACILITY NUMBER: 434414441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2022
Section Cited
CCR
101223(a)(3)

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of
pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of
a punitive nature. This requirement was not met as evidenced by:

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Licensee will submit to LPA Cruz a proof of in-service training conducted to preschool staff regarding personal rights by POC date 7/11/22. Training must focus on the appropriate forms of discipline to children.

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Based on interviews and record reviews, Licensee did not comply with section cited above. A
child’s personal rights was violated when child was forcefully pulled out from the facility garden
and was grabbed by the wrist by a preschool staff which posed an immediate health, safety or
personal rights risk to persons in care.

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Licensee must provide copies of this report to parents/guardians of children in care and to parents/guardians of children newly enrolled during the next 12 months per the AB633 requirements.


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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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022


LIC809 (FAS) - (06/04)
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