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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415126
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:59:45 PM

Document Has Been Signed on 09/12/2022 02:59 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:PRECIOUS MOMENTS PRESCHOOLFACILITY NUMBER:
434415126
ADMINISTRATOR:PRIYANKA BANSALFACILITY TYPE:
850
ADDRESS:330 SOUTH MONROE STREETTELEPHONE:
(408) 931-6218
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 36TOTAL ENROLLED CHILDREN: 33CENSUS: 19DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Maria Guzman & Priyanka BansalTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year Inspection. LPA met with Site Director, Maria Guzman. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The preschool program has no active waivers. The center's operating hours are Monday through Friday 08:15 AM to 5:30 PM. The facility serves children ages 2 years to 6 years old. Licensee Representative, Priyanka Bansal, arrived during the inspection and met with LPA.

LPA toured the facility both indoor and outdoor. LPA observed an adult student who is enrolled or participating at an accredited educational institution was left supervising nine (9) children in the playground while the Site Director went to the front door to attend to children being dropped off to the facility. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. LPA observed a bathroom available for the children and is sanitary and operable. The bathroom is comprises of three (3) toilets and three (3) sinks.

Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via individual water bottles and water fountains. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, working smoke and carbon monoxide detectors were observed.

Priyanka stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via individual water bottles. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopy, patio and a tree. LPA observed rubber foams as resilient material under the climbing structures. There were no bodies of water observed.

Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PRECIOUS MOMENTS PRESCHOOL
FACILITY NUMBER: 434415126
VISIT DATE: 09/12/2022
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LPA reviewed 10 children's files. Children's records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, and Immunization.

Three (3) staff files were reviewed. LPA reminded Licensee Representative that the online AB1207 Mandated Reported Training needs to be renewed every two years. Site Director has current certifications in Pediatric CPR and First Aid.

This facility provides Incidental Medical Services – IMS. Priyanka stated that currently, there are no children using medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Priyanka was 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. LPA observed Kayleh Casas working at the facility with pending fingerprint clearance. Kayleh stated she has been working at the facility for 5 days or more. Civil penalty of $500.00 was assessed.

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/process.

Continuation on next page:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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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: PRECIOUS MOMENTS PRESCHOOL
FACILITY NUMBER: 434415126
VISIT DATE: 09/12/2022
NARRATIVE
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As a result of this inspection, deficiencies were cited on the following page:

Exit interview conducted and report was reviewed with the Licensee Representative, Priyanka Bansal.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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Document Has Been Signed on 09/12/2022 02:59 PM - It Cannot Be Edited


Created By: Marilou Monico On 09/12/2022 at 01:33 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: PRECIOUS MOMENTS PRESCHOOL
FACILITY NUMBER: 434415126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101229(a)(1)
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 is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, an adult student who is enrolled or participating at an accredited educational institution was left supervising nine (9) children in the playground while the Site Director went to the front door to attend to children being dropped off to the facility. This poses an immediate risk to the health, safety or personal rights risk of children in care.
POC Due Date: 09/13/2022
Plan of Correction
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Priyanka submitted a written Plan of Correction during the inspection to ensure that all children are supervised by a fully qualified teacher and not left alone by a teacher's aide or student.
Deficiency corrected.
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, staff statement, and record review, Kayleh Casas has been working at the facility for five (5) days or more with pending fingerprint clearance. This poses an immediate risk to the health, safety or personal rights of children in care.
POC Due Date: 09/13/2022
Plan of Correction
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Priyanka submitted a written Plan of Correction during the inspection to ensure that staff receives fingerprint clearance prior to working in the facility.

Deficiency corrected.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022


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