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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415215
Report Date: 11/18/2022
Date Signed: 11/18/2022 09:57:46 AM

Document Has Been Signed on 11/18/2022 09:57 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: 12CENSUS: 8DATE:
11/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Maria AtkinsTIME COMPLETED:
10:20 AM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz met with Maria Atkins, Licensee / Director, to conduct an unannounced case management. Purpose of visit is to correct report dated 8/30/22 that was entered on the wrong form. LPA observed eight preschool children with Maria Atkins in classroom #1.

A deficiency was cited during the visit on 8/30/22. See 809D.

An exit interview was conducted with Maria Atkins, Licensee/Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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 11/18/2022 09:57 AM - It Cannot Be Edited


Created By: Janette Cruz On 11/18/2022 at 09:24 AM
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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
1596.8662(4)(b)(1)

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1596.8662 (4)(b)(1)On or before 03/30/18, a person who on 01/01/18 is a licensed child day care provider shall complete the mandated reporter training......every two years following the date on which she completed the initial mandated reporter training. This requirement is not met as evidenced by:
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Licensee will submit her mandated reporter training certificate by POC due date.
Plan of correction was cleared on 9/1/22.
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Based on observation, interviews and record reviews, Licensee/Director does not have a current mandated reporter training certificate on file which poses a potential threat on health and safety of children.
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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: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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