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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415215
Report Date: 09/09/2022
Date Signed: 09/15/2022 11:26:20 AM

Document Has Been Signed on 09/15/2022 11:26 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:LIDIA'S PRESCHOOL AND DAY CARE CENTERFACILITY NUMBER:
434415215
ADMINISTRATOR:ATKINS, MARIAFACILITY TYPE:
850
ADDRESS:637 CALERO AVENUETELEPHONE:
(669) 234-7886
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 18TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
09/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria Atkins and David AtkinsTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Janette Cruz and Araceli Almaraz, met with Maria Atkins and David Atkins, Licensees, for an unannounced case management inspection as a follow-up visit from a complaint inspection conducted on 9/7/2022. Licensee, Maria Atkins, granted LPA's access to the facility. LPAs observed ten preschool children present during today's inspection. LPAs returned to the facility today as a continuation of observations from 9/7/22 (Reference LIC9099 and LIC9099D).

On 09/07/22, LPAs Cruz and Almaraz arrived at this facility at 9:22 AM, to obtain additional information regarding complaint allegations. LPAs were granted entry in to the facility by Licensee/Director Atkins. Upon entry there was one cleared adult (Director Atkins, Maria) with 4 children in care, child (C) C1 through C4, Director stated that there were no other children in care.

LPA Cruz asked for access to two off limit classrooms 2 and 3; Classroom 3 was locked. Director Atkins stated that the key was with someone "from the church”, which is adjacent to the facility. Director Atkins called the church and stated that this person could not be reached. LPA Cruz stated that the LPAs needed access to the locked room. LPA Almaraz went to the playground area of the facility and checked the backside through a fence. LPA Almaraz asked for access to the back of the facility, Director Atkins stated that access was only through the church. LPA Almaraz went to the adjacent church, Valley of the Nazarene. A church worker granted LPA Almaraz access to the church. Around 10:15 AM, LPA Cruz heard children in the outdoor back area by the church, LPA Almaraz walked outside and also heard children.

LPA Almaraz walked through the church and into the back area and did not observe any children in care. LPA Almaraz heard children and walked behind a fenced shed. LPA Almaraz observed two additional adults identified as A1 and A2, with children identified as C5 to C12, which were eight additional children in care. LPA Almaraz notified LPA Cruz that there were 8 children, pre-school age, behind a shed. LPA Almaraz and LPA Cruz returned to the area, where the two adults and 8 children were. LPA Cruz was able to verify that the adults were not
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215
VISIT DATE: 09/09/2022
NARRATIVE
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fingerprint cleared. LPAs observed the children in care were in an unauthorized area, where there was not adequate shade during county issued excessive heat warning and as of 11AM, temperature was at 93 F. LPAs observed children were panting and there was no access to outdoor water. LPAs observed hazards such as a ladder/s, tree logs, sharp tree branches, weeds and dry grass in this area. LPAs observed this facility was operating out of scope of license. LPAs observed facility was in violation of fire clearance by using off limit classroom #3, that have not been cleared by the Fire Department and are being used for the children in care.

LPAs informed Director Atkins that the children cannot be in an unauthorized area, with hazards, and inadequate shade. LPAs observed at approximately 11:20 AM children in care returned to the facility. The San Jose Police Department (SJPD) were called for a wellness check due to Director Atkins, when asked by the LPAs, did not provide the names of adults A1 and A2 who were with the eight children in care. SJPD declared that children were unharmed.

Exit interview was conducted with Licensees, Maria and David Atkins.

A Notice of Site Visit was issued and must be posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/09/2022
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Page: 2 of 7
Document Has Been Signed on 09/15/2022 11:27 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/13/2022 04:53 PM


Created By: Janette Cruz On 09/09/2022 at 02:02 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2022
Section Cited
CCR
101216(3)

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Teacher-Child Ratio. (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance....This requirement was not met as evidenced by,
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Licensee will submit to the Department by POC due date, a written plan of understanding of the regulation on teacher/child ratio and provide a detailed plan to manage supervision of children with adequate teacher ratio at all times.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above.. LPAs Cruz and Almaraz observed children (c5-c12) outside of the perimeter of the license with two adults (1-2) that did not have fingerprint clearances and were both not qualified teachers. This poses an immediate threat to the health and safety of the children in care.

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

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


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Document Has Been Signed on 09/15/2022 11:28 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/13/2022 04:54 PM


Created By: Janette Cruz On 09/09/2022 at 02:11 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2022
Section Cited
CCR
101223(a)(3)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from withholding of shelter. This requirement was not met as evidenced by:
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Licensee needs to submit a written plan of correction (POC) to the Department in regard to personal rights of children by POC due date. The POC needs to include that each child shall be accorded safe, healthful and comfortable accommodations. The POC must also provide steps to prevent personal rights violation from occurring again in the future.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. LPA’s Cruz and Almaraz observed 8 children being held outside for at least one hour in extreme heat, being confined to a small area by a shed. This poses an immediate threat to the health and safety of the children.
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Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements. Possible compliance office meeting.
Type A
09/12/2022
Section Cited
CCR101223(a)(2)

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: 2) To be accorded safe, healthful and comfortable accommodations. This requirement was not met as evidenced by:
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Licensee needs to submit a written plan of correction (POC) to the Department in regard to personal rights of children by POC due date. The POC needs to include that each child shall be accorded safe, healthful and comfortable accommodations. The POC must also provide steps to prevent personal rights violation from occurring again in the future.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. LPAs Cruz and Almaraz observed children did not have water while being kept outside in extreme heat. This poses an immediate threat to the health and safety of the children in care.
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Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements. Possible compliance office meeting.
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: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


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Page: 4 of 7
Document Has Been Signed on 09/15/2022 11:29 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/13/2022 04:55 PM


Created By: Janette Cruz On 09/09/2022 at 02:17 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2022
Section Cited
CCR
101238.2(d)(2)

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Outdoor Activity Space(d) The surface of the outdoor activity space shall be maintained:(2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
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Licensee will submit to the Department in regard to personal rights of children by POC due date. The POC needs to include that each child shall be accorded safe, healthful and comfortable accommodations. The POC must also provide steps to prevent personal rights violation from occurring again in the future.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. LPAs Cruz and Almaraz observed children in area that were not free from hazards including, but not limited to, logs, ladders, other debris, and dry grasses that pose a fire hazard, during in extreme heat with county and state warnings of the heat. The door to return to the facility was locked by the Director. There was no adequate alternate exit out of the area. This poses an immediate threat to the health and safety of the children in care.

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Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements. Possible compliance office meeting.
Type A
09/09/2022
Section Cited
CCR101663(a)

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False Claims (a) No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the childcare center This requirement was not met as evidenced by:
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Licensee will submit a written plan of correction to the Department by POC due date regarding understanding of this regulation and how to prevent from occurring again in the future.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. Licensee stated there was no key for Room
#3, employees provided false names and Licensee did not disclose the total number of children by not telling the children's whereabouts. This poses an immediate threat to the health and safety of the children in care.
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Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements. Possible compliance office meeting.
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: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


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Page: 5 of 7
Document Has Been Signed on 09/15/2022 11:29 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/13/2022 04:58 PM


Created By: Janette Cruz On 09/09/2022 at 02:20 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2022
Section Cited
HSC
1596.841

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Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request. This poses a potential threat to the health and safety of the children in care.
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Licensee submitted a complete LIC9040 Child Care Facility Roster with complete information required in the form for all children enrolled during today's visit

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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. Licensee did not disclose the total number and information of children enrolled in her current facility roster provided to LPAs during visit. This poses a potential threat to the health and safety of the children.
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Type B
09/16/2022
Section Cited
CCR101214(A)

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Accountability(A) The licensee whether an individual or other entity, is accountable for the general supervision of the licensed child care center and for the establisment of policies concerning its operation
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Licensee needs to submit a written plan of correction(POC) to the Department by POC due date, in regard to Accountability, to include licensee understands an individual or other entity, is accountable for the general supervision of the licensed child care center and for the establishment of policies concerning its operation. The POC must also provide steps to prevent an Accountability violation from occurring again in the future.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above.
LPAs Cruz and Almaraz observed Director/Licensee Atkins, Maria did not adhere to general supervision and policies, including use of off limit areas, leaving children with uncleared adults, not ensuring assistants are qualified. This poses a potential threat to the health and safety of the children in care.
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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: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/15/2022 11:30 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/13/2022 04:59 PM


Created By: Janette Cruz On 09/09/2022 at 02:30 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2022
Section Cited
CCR
101217(B)(1)(2)

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. Personnel Records. Personnel records shall be maintained for all volunteers and shall contain the following: (1) A health statement as specified in Section 101216(g). (2) Tuberculosis test documents as specified in Section 101216(g)
This requirement was not met as evidenced by:
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Licensee needs to submit a written plan of correction (POC) to the Department by POC due date, in regard to the Volunteers, and to include that licensee understands, each volunteer who works in the center shall be verified by: (A) A statement signed by each volunteer affirming that he/she is in good health. (B) Results of a test for tuberculosis performed not more than one year prior to or seven days after initial presence in the center. The POC must also provide steps to prevent a Volunteer violation from occurring again in the future
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. LPAs Cruz and Almaraz observed there was no documentation for adult A1, This poses a potential threat to the health and safety of the children in care.
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Type B
09/16/2022
Section Cited
HSC1596.8595(c)

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Health and Safety Code Section 1596.8595 (c) A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b. This requirement is not met as evidenced by:

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Licensee will submit a written Plan of Correction addressing the correct protocol for posting licensing reports and providing reports to parents or guardians of each child receiving services as per Health and Safety code 1596.8595

Licensee will provide a copy of LIC 9099 dated 09/07/2022 and will obtain parents’ signatures as proof of notification that parents received the copy of the LIC9099/LIC9099D by POC due date,


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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. Licensee did not provide copies of the LIC 9099 and LIC 9099 D documenting Type A citations issued to the facility as per parents statements. LPA also observed that Licensee also did not post the LIC9099 and LIC 9099D inside the facility.
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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: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


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