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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415126
Report Date: 05/15/2025
Date Signed: 05/15/2025 03:23:59 PM

Document Has Been Signed on 05/15/2025 03:23 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:PRECIOUS MOMENTS PRESCHOOLFACILITY NUMBER:
434415126
ADMINISTRATOR/
DIRECTOR:		PRIYANKA BANSALFACILITY TYPE:
850
ADDRESS:330 SOUTH MONROE STREETTELEPHONE:
(408) 320-2149
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 34DATE:
05/15/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Priyanka BansalTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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On May 15, 2025 at 11:15 AM, Licensing Program Analyst (LPA), Marilou Monico, met with Site Director, Priyanka Bansal, for an unannounced Annual Required Inspection. LPA provided Site Director the Entrance Checklist (LIC 125). The facility operates Monday thru Friday from 8:00 AM to 5:30 PM. The preschool program serves children ages 2-6 years old in Rooms: 1,2, 3, and Entryway/Play area.

LPA toured the indoor and outdoor areas of the facility. The facility is within ratio & capacity compliance today. The classrooms have age-appropriate materials, toys, furnishing, equipment, & adequate storage for children’s belongings. The children's napping equipment were observed to be stored in a healthful manner. Bedding is provided by parents and is washed weekly. LPA observed functioning smoke and carbon monoxide detectors. There is a fully charged 3A40BC fire extinguisher serviced in April 2025. The isolation area for sick children is the Office.

The center provides breakfast and lunch to children. Parents provide snacks. All center provided food items are properly labeled & stored separately from cleaning supplies. There is food preparation area in Room 1 that is equipped with microwave, Instapot, rice cooker, toaster, and a sink with hot and cold running water. Breakfast and lunch menus are posted one week in advance, available for review, & dated. Solid waste bins are equipped with tight fitting lids. Drinking water is accessible by children in the classrooms via individual water bottles. The staff and children's bathrooms are clean, sanitary and operable.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Marilou Monico
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2025
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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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: PRECIOUS MOMENTS PRESCHOOL
FACILITY NUMBER: 434415126
VISIT DATE: 05/15/2025
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The outdoor play area is fully fenced. Shade is provided by canopies, tree and building overhang . All equipment and surfaces are free from hazards. There are no bodies of water on the premises. There are age-appropriate outdoor toys and materials for the children. The slides play structure is securely installed into the ground and the ground surrounding the play structure is sufficiently padded (rubber foam) and in good condition for safety. LPA observed that the spider web climbing structure has rubber foam as resilient material under, however there is no cushioning around the structure to absorb falls. Site Director stated that she will not allow children to use it for now until the cushioning is installed. Site Director stated that she will place a barricade around the structure or install resilient material this week and will submit photo to Licensing by 05/19/25. Drinking water is provided in individual water bottles. Per Site Director, there are no firearms or weapons on the premises.

All individuals subject to criminal record review have fingerprint clearances and associated to the facility. LPA reviewed the facility roster and obtained a copy during the inspection. At least one staff member has a current Pediatric CPR/First-Aid Certification. LPA observed all required postings in a publicly accessible area. LPA reviewed the sign in/out sheet for today and all children were signed in. Fire/disaster drill was conducted on February 28, 2025.

LPA reviewed ten (10) random children files during today's inspection for the following records: Admission Agreement, Personal Rights (613A), Identification and Emergency Information (LIC700), Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Physician’s Report (LIC 701), TB test and Immunization records.



LPA reviewed four (4) staff files for the following records: Health Screening Report (LIC 503) with TB test, Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee rights (LIC 9052), staff qualifications, immunization records, and required training. Site Director was reminded of their responsibility to renew CPR/First Aid and Mandated Reporter Training every two years.

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.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Marilou Monico
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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: PRECIOUS MOMENTS PRESCHOOL
FACILITY NUMBER: 434415126
VISIT DATE: 05/15/2025
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Site Director, Priyanka Bansal, was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).



LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN-22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice 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/resources/child-care-centers/.



Site Director, Priyanka Bansal, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA reminded Site Director to report unusual incidents or injuries to children in care to the Department of Social Services using the Unusual Incident/Injury Report form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 calendar days.

As a result of this inspection, there were no deficiencies cited.

A Notice of Site Visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with Site Director, Priyanka Bansal.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Marilou Monico
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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