434414441-7-13-2023-07-CC-DVIA-CTPV7E-20230713161103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414441
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:11:08 PM

Document Has Been Signed on 07/13/2023 04:11 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PS		FACILITY NUMBER:	434414441
ADMINISTRATOR:	CORTEZ, ELVIRA		FACILITY TYPE:	850
ADDRESS:	1399 SANTEE DRIVE		TELEPHONE:	(408) 573-4823
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY: 181	TOTAL ENROLLED CHILDREN: 92	CENSUS: 36	DATE:	07/13/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Araceli Fonseca/Renee Garcia		TIME COMPLETED:	04:20 PM

NARRATIVE

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Licensing Program Analyst (LPA) Deanna Villagrana met with Program Manager Araceli Fonseca and Site Supervisor Renee Garcia for a case management inspection to follow-up on a unusual incident that was self-reported to and received by Licensing on 07/07/2023. LPA observed 11 children with two staff in Cottonwood 3 room, 10 children with two staff in Cottonwood 4 room and 15 children with two staff in Madrone 15 room. All staff are cleared through Santa Clara County Office of Education.

On 07/07/2023, Site Supervisor Renee Garcia reported on 07/06/2023 at around 9:50am -10:00am child 1 left through the back door of Maple 3 classroom and was outside for less than a minute without supervision. The back door leads to a gated outdoor area. There were nine children with two staff present in the classroom. According to Araceli Fonseca, a staff member from Maple 4 classroom observed the child outside and went outside to get child within 45 seconds.

The following type A deficiency was cited on the attached page (809-D). No immediate civil penalty for Zero Tolerance of $500 was issued due to facility being part of Department of Education.

LPA Deanna Villagrana informed Site Supervisor Renee Garcia that this report dated 07/13/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the Site Supervisor Renee Garcia to provide a copy of this licensing report dated 07/13/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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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Document Has Been Signed on 07/13/2023 04:11 PM - It Cannot Be Edited

Created By: Deanna Villagrana On 07/13/2023 at 03:29 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: 07/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/13/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	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.	1 2 3 4 5 6 7	Renee Garcia stated that staff S2 was issued a written Reprimand for Unsatisfactory Performance and will be attached to their file permanently. S3 has not been present at the facility and will be issued the same written letter upon return. A Plan of Expectation regarding supervision was issued to all staff. Staff will begin doing a 30 minute head count daily. Deficiency cleared.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by Site Supervisor Renee Garcia reported on 07/06/2023 at around 9:50am -10:00am child 1 left through the back door of Maple 3 classroom and was outside for less than a minute without supervision. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Mary Segura

LICENSING EVALUATOR NAME:

Deanna Villagrana

LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PS	FACILITY NUMBER: 434414441
	VISIT DATE: 07/13/2023

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A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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