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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415355
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:31:54 AM

Document Has Been Signed on 05/09/2024 11:31 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:AGAPE CHRISTIAN PRESCHOOL OF SAN JOSEFACILITY NUMBER:
434415355
ADMINISTRATOR/
DIRECTOR:		JUHEE DOFACILITY TYPE:
850
ADDRESS:1229 NAGLEE AVENUETELEPHONE:
(408) 472-8288
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 31TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
05/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Soohoo Lee and Juhee DoTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Cortney Nelson conducted an unannounced Plan of Correction (POC) inspection. LPAs met with Licensee Soohoo Lee and explained the reason for the inspection. The purpose of this inspection is the center was cited on 05/01/2024 for ratio.

During today's inspection, LPAs conducted observation. Upon arrival, S-1 was in the room by themselves. S-1 is currently enrolled in courses, but does not have completion of any courses. Licensee walked out from the office back to the room. LPA discussed with Director that S-1 cannot be left alone with children since they do not qualify as a teacher.

At 9:01PM, LPA observed that staff from facility #434415356 came into the building and brought children. Facility's waiver request to commingle children in the morning with facility #434415356 has not been granted yet. Director stated that she understand on 05/01/2024 that they needed to cease commingling the children in the morning until waiver request has been granted.

LPAs also reviewed LIC 9224. A copy of the report was sent to all parents via app that they use. Director understands that the center needs to be have parents sign the LIC 9224 or submit a written confirmation that they received the report.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/09/2024 11:31 AM - It Cannot Be Edited


Created By: Samantha Yip On 05/09/2024 at 10:19 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: AGAPE CHRISTIAN PRESCHOOL OF SAN JOSE
FACILITY NUMBER: 434415355

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2024
Section Cited
CCR
101216.3(a)

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Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...
This requirement is not met as evidenced by:
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By POC 05/102/2024, Director will submit plan on how she will ensure the center is within ratio at all times.
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Based on observations, LPAs observed upon arrival that S-1 was alone with the children. The Licensee was in the office at the time, then stepped out to the room. This poses an immediate health and safety 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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024


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Document Has Been Signed on 05/09/2024 11:31 AM - It Cannot Be Edited


Created By: Samantha Yip On 05/09/2024 at 10:23 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: AGAPE CHRISTIAN PRESCHOOL OF SAN JOSE
FACILITY NUMBER: 434415355

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2024
Section Cited
CCR
101238.3

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Indoor Activity Space. There shall be at least 35 square feet of indoor activity space per child based on the total licensed capacity.
This requirement is not met as evidenced by:
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Director will seize commingling children until waiver has been granted
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Based on observation, LPAs observed that children from facility #434415356 were being dropped off at this center. This poses an potential health and safety risk to children in care.
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By POC 05/16/2024, Director submitted written statement that she understands.

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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024


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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: AGAPE CHRISTIAN PRESCHOOL OF SAN JOSE
FACILITY NUMBER: 434415355
VISIT DATE: 05/09/2024
NARRATIVE
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-----------------continuation of 809 dated 05/09/2024 page 1--------------------

As a result of this inspection, a Type A and Type B citation was issued. A civil penalty of $250 was issued for repeat violation. Exit interview conducted and report was reviewed with Director Juhee "Julie" Do. A notice of site visit has been issued.

LPA Samantha Yip informed Director Juhee Do that this report dated 05/09/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director to provide a copy of this licensing report dated 05/09/2024 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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