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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415215
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:59:51 PM

Document Has Been Signed on 07/10/2024 01:59 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LIDIA'S PRESCHOOL AND DAY CARE CENTERFACILITY NUMBER:
434415215
ADMINISTRATOR/
DIRECTOR:		ATKINS, MARIAFACILITY TYPE:
850
ADDRESS:637 CALERO AVENUETELEPHONE:
(669) 234-7886
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 18TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Maria AtkinsTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Maria Atkins for a Case Management visit. LPA explained the nature of the visit. LPA observed licensee with nine day care children. One child was picked up and four additional children arrived during visit. Licensee's volunteer Patricia Cruz arrived an hour later.

LPA observed one child have to go to the bathroom during visit. Child went running to the bathroom which is through a hallway on the other side of classroom one. Maria tried getting all children to go to the bathroom area while they were playing. Some children were in the bathroom area down the hallway and others still in the playroom. Maria was located in the playroom and had no supervision of children in the bathroom. During the visit a child ran into area where LPA was typing report that is located on the right side of main play area. Child was not being supervised. LPA observed spider webs around inside of the facility including some shelves, window seals, ceilings and on outdoor play structures. LPA observed room 2 smelled musty and was cluttered with recycles and children's items. A piece of the ceiling was removed and LPA observed black mold growing on the piece and on ceiling. LPA observed two window air conditioners with dirty filters. LPA observed children were missing from roster. LPA observed child 1 is missing immunization records. LPA observed child 3, 4, and 5 are missing LIC613a. Child 5 and 12 is missing LIC995.

During the visit, LPA observed children being put down for nap. There were three children placed in the small room were LPA completed report that does not have good visual view from the main room. LPA observed from 1:03pm until 1:24pm children were not supervised. There is not enough staff to cover napping areas or needs of the facility when licensee needs to go into the office to get requested items from licensee or take children to the bathroom.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215
VISIT DATE: 07/10/2024
NARRATIVE
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The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Deanna Villagrana informed licensee Maria Atkins that this report dated 07/10/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Maria Atkins to provide a copy of this licensing report dated 07/10/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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Document Has Been Signed on 07/10/2024 01:59 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/10/2024 at 12:41 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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2024
Section Cited
CCR
101229(a)(1)

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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 was not met as
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Licensee will submit a plan to ensure children are supervised at all times to CCLD by POC date.
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evidenced by Some children were in the bathroom area down the hallway and others still in the playroom. Maria was located in the playroom and had no supervision of children in the bathroom. During the visit a child ran into area where LPA was typing report that is located on the right side of main play area. Child was not being supervised. This poses an immediate risk to the Health, Safety or Personal Rights to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


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Document Has Been Signed on 07/10/2024 01:59 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/10/2024 at 12:47 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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
101238(a)

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The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by LPA observed spider webs around inside of the facility including window seals,
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Licensee will clean facility and submit photos to CCLD by POC date. A letter will be required from church regarding black mold and how it will be fixed to ensure children are safe.
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ceilings and on outdoor play structures. LPA observed room 2 smelled musty and was cluttered with recycles and children's items. A piece of the ceiling was removed and LPA observed black mold growing on the piece and on ceiling….This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
07/17/2024
Section Cited
CCR101223(a)(2)

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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by LPA observed two window air conditioners with dirty filters.
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Licensee will clean filters and submit photos to CCLD by POC date.
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This poses a potential risk Health, Safety Personal Rights risk to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


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Document Has Been Signed on 07/10/2024 01:59 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/10/2024 at 01:01 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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
HSC
1596.841

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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.
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Licensee will submit updated roster to CCLD by POC date.
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This requirement was not met as evidenced by LPA observed children were missing from roster. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
07/17/2024
Section Cited
CCR101223(b)(1)

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The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement was not met as evidenced by LPA observed child 3, 4, and 5 are missing LIC613a.
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Licensee will submit LIC613a for child 3, 4, and 5 to CCLD by POC date.
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This poses a potential risk Health, Safety Personal Rights risk to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


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Document Has Been Signed on 07/10/2024 01:59 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/10/2024 at 01:06 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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
101220.1(g)

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The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement was not met as evidenced by LPA observed child 1 is missing immunization records.
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Licensee will submit immunization records for child 1 to CCLD by POC date.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
07/17/2024
Section Cited
CCR101218.1(e)(1)

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The licensee shall request the child’s parent or authorized representative to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 995 (8/02). The bottom portion of this form must be kept in the child's file as proof that the parent or authorized representative has been notified of his or her rights by the child care center and received a copy of the LIC 995E, Caregiver Background Check Process form.
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Licensee will submit LIC995 for child 5 and 12 to CCLD by POC date.
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This requirement was not met as evidenced by Child 5 and 12 is missing LIC995. This poses a potential risk Health, Safety Personal Rights risk to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/10/2024 01:59 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/10/2024 at 01:27 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: LIDIA'S PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 434415215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
101216(b)

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The Department has the authority to require any licensee to provide additional staff whenever the Department determines and documents that additional staff are required for the provision of services necessary to meet the needs of children in care. The licensee shall be informed in writing of the reasons for the Department's determination.
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Licensee will submit a plan stating she will be hiring more staff to assist at the facility. Additional staff member must be a fully qualified teacher to meet the needs of the children. A plan is required to be submitted to CCLD by POC date.
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This requirement was not met as evidenced by LPA observed from 1:03pm until 1:24pm children were not supervised. There is not enough staff to cover napping areas or needs of the facility when licensee needs to go into the office to get requested items from licensee or take children to the bathroom. This poses a potential risk Health, Safety Personal Rights risk to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


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