<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415300
Report Date: 02/08/2024
Date Signed: 02/08/2024 05:08:22 PM

Document Has Been Signed on 02/08/2024 05:08 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:ENGENIUS LEARNING CENTER @ BOOKSIN ELEMENTARYFACILITY NUMBER:
434415300
ADMINISTRATOR:IKEMOTO, DOUGFACILITY TYPE:
840
ADDRESS:1590 DRY CREEK ROADTELEPHONE:
(408) 785-1599
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 150TOTAL ENROLLED CHILDREN: 176CENSUS: 126DATE:
02/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Doug Ikemoto and David WalterTIME COMPLETED:
05:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Doug Ikemoto, and Assistant Site Director, David Walter, for an unannounced Required- 3 Year Inspection. LPA was granted access to the facility by Doug and David and toured both indoors and outdoors during the inspection. The child care center is located at Booksin Elementary School and primarily uses classroom F for the care of school-age children. Upon dismissal from school, there were one hundred twenty six (126) school-age children and eleven (11) staff members present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, before school 6:30AM-8:30AM and after school 2:00PM-6:00PM.

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire/disaster drill was conducted on 12/18/2023, which is compliant with the six-month requirement. LPA observed two fully charged 3A40BC fire extinguishers (last serviced: 7/2024), built in fire detection system that is maintained annually by the Fire Department, and a functioning carbon monoxide detector. David states that the center does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. There are no weapons or firearms on the premises.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: ENGENIUS LEARNING CENTER @ BOOKSIN ELEMENTARY
FACILITY NUMBER: 434415300
VISIT DATE: 02/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. The facility is licensed to utilize classrooms 5, 6, 7, 8, 24, and the library and Doug states that these classrooms are primarily used on rainy days or as needed. The center primarily utilizes classroom F, which is divided into two separate rooms, for the care of children. LPA observed sufficient age-appropriate materials, toys, and play equipment. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children via classroom drinking fountains and children additionally have water bottles from home labeled with their names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom which an isolated child could use if necessary. There is a working telephone in the facility.

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. The Director states that water lead testing has not been completed for the facility and LPA advised that it is required for all centers, including those that are located on elementary school campuses.

The outdoor areas were inspected and observed to be fenced in. The TK/K enrolled in the program use the kinder playground and 1st-5th utilize the park area. Equipment is provided by Engenius while the children play outside and staff visually supervise the children as they play. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (turf) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by large trees and building overhang.

The facility offers a half day program and provides AM/PM snack to children. The menu is in writing and posted at least one week in advance, accessible to authorized representatives with portion sizes indicated. The kitchen and storage area is clean and free of litter and rubbish. LPA advised that snacks which have already been open and are not packed for individual use, such as carrot sticks and cereal, shall be placed into a re-sealable container and labeled with the date opened and expiration date. LPA additionally advised keeping track of expiration date for snacks served to children and prioritize serving those which will expire soonest. The facility may consider having staff review the fridge and pantry at the end of the week for food items that have expired and toss them.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ENGENIUS LEARNING CENTER @ BOOKSIN ELEMENTARY
FACILITY NUMBER: 434415300
VISIT DATE: 02/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Five (5) children’s files were reviewed and all required documents were present.

Seven (7) staff files were reviewed and most required documents were present. LPA advised printing documents from email, such as Mandated Reporter certificates, transcripts, and other documents provided by staff to ensure they are in the file for review during inspections. David has current CPR/First-Aid that expires 6/2024 and current Mandated Reporter Training that expires on 3/7/2025. LPA reminded that the Mandated Reporter Training must be renewed by all staff every 2 years.

Licensee 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.

The Site Director understands that he shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded that there shall be at least one person with valid CPR and First-Aid certifications on site at all times or present during off site activities, such as field trips.

Exit interview conducted and report was reviewed with the Site Director, Doug Ikemoto.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/08/2024 05:08 PM - It Cannot Be Edited


Created By: Cortney Nelson On 02/08/2024 at 04:31 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: ENGENIUS LEARNING CENTER @ BOOKSIN ELEMENTARY
FACILITY NUMBER: 434415300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record reviews, the licensee did not comply with the section cited above as the facility has not yet completed water lead testing for faucets used for drinking water or food prep, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
1
2
3
4
The facility shall schedule water lead testing for the facility to test any faucets that are used for food preparation or drinking water. LPA advised following the directives indicated in PIN 21-21.1-CCP and submitting LIC9275, LIC9276, and a facility sketch (LIC999) with faucets tested indicated.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above for one out of seven staff members and multiple were missing influenza or declination, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
1
2
3
4
The Site Director shall submit proof of immunizations for S1 and influenza or declination for S2, S3, and S4 to the Department by 2/23/2024.
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:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 02/08/2024 05:08 PM - It Cannot Be Edited


Created By: Cortney Nelson On 02/08/2024 at 04:31 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: ENGENIUS LEARNING CENTER @ BOOKSIN ELEMENTARY
FACILITY NUMBER: 434415300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101227(a)(1)
Food Service
(a) In child care centers providing meals to children, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by
Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for
Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe
and healthful manner.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as snack items which are not single servings were observed to be in opened, non-sealed containers, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2024
Plan of Correction
1
2
3
4
The Site Director shall purchase re-sealable containers for food items that are not in individual containers and label with the date the food item was opened and the expiration date. Proof of storage methods shall be submitted to the Department by 2/16/2024. LPA additionally advised monitoring food supplies for items that may have expired and disposing of food that is expired.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5