434414503-10-24-2023-52-CC-MESA-CWWQEK-20231024120628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414503
Report Date: 10/24/2023
Date Signed: 10/24/2023 12:06:35 PM

Document Has Been Signed on 10/24/2023 12:06 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ST. THOMAS PRESCHOOL		FACILITY NUMBER:	434414503
ADMINISTRATOR:	EFREN LORENZ TIGAS		FACILITY TYPE:	850
ADDRESS:	200 NORTH ABBOTT AVENUE		TELEPHONE:	(408) 946-0190
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY: 68	TOTAL ENROLLED CHILDREN: 68	CENSUS: 24	DATE:	10/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	DIRECTOR EFREN TIGAS		TIME COMPLETED:	12:15 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 Tuesday, October 24, 2023 at 9:45 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an Required One (1) Year Visit. LPA met with the Director Efren Tigas and explained the nature of site visit. Present on this visit were 5 staff and 24 preschool children. Facility operates from Monday to Friday 8 am to 6 pm. LPA toured the facility to conduct a Health and Safety Inspection with the Director. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules, and Waiver were observed to be posted. Facility was observed to be following teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. Facility has a total of 3 operating classroom, Dolphin Room, Parrot Room and Rainforest Room. The classrooms, restrooms, storage rooms and office area were inspected. There are outdoor children's bathrooms located next to the outdoor storage area and Staff Restroom is located inside the Church next to the outdoor play area. The Director stated that children are being assisted and supervised when using the bathroom. The sick child will use the staff bathroom if needed. The sick child will be isolated in the multi-purpose room located in the church building. Restrooms were observed to be in safe, sanitary, and functioning condition. The Director stated that facility does not possess nor store any weapons on the premises. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazard. Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST. THOMAS PRESCHOOL	FACILITY NUMBER: 434414503
	VISIT DATE: 10/24/2023

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
26
27
28
29
30
31
32

LPA reviewed and or discussed the following;

1. Facility file which Fire and Earthquake Drills were conducted and documented on 06/23/2023 and 10/19/2023 respectively. LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations and fire extinguishers. LPA reviewed the facility's 2023 Fire Department Permit.
2. Children’s Sign in and Out Records. Children's Schedule, Children's Roster and Children's Sign in for the day.
3. Staff Files. Each file includes Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Education Qualification, records of immunization (Measles and Pertussis), and Training such as the AB1207 Mandated Reporter Certification. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection.
4. Children Files. Each child’s file contains but not limited to records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization.
5. Facility does not provide transportation for children, but the Director understands that children cannot be left alone, unattended in park vehicles.
6. Childcare Expansion Grant Program, the Santa Clara County Childcare Resource and Referral (R&R) Program 2023-2024 HEALTH AND SAFETY TRAINING REIMBURSEMENT and FREE training is available to Santa Clara County Mandated Reporters working at daycare/childcare facilities
7. PIN 23-08-CCP - 2022 Chaptered Legislation Affecting Child Care Facilities
8. October 2022 Menu. Children bring their lunch and facility provides am and pm snacks.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual -Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST. THOMAS PRESCHOOL	FACILITY NUMBER: 434414503
	VISIT DATE: 10/24/2023

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
26
27
28
29
30
31
32

Directors were reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

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.

Exit interview conducted and report was reviewed with the Director Efren Tigas.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5