434415557-3-19-2024-07-CC-SCHN-D3HPDD-20240319111320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415557
Report Date: 03/18/2024
Date Signed: 03/19/2024 11:13:46 AM

Document Has Been Signed on 03/19/2024 11:13 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	FOOTHILL HEAD START		FACILITY NUMBER:	434415557
ADMINISTRATOR:	ROOPALI BORN		FACILITY TYPE:	850
ADDRESS:	2750 RIVERRUN DRIVE		TELEPHONE:	(408) 392-3891
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 16	DATE:	03/18/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Roopali Born		TIME COMPLETED:	04:45 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	Page 1. On 3/18/24 Licensing Program Analyst (LPA), Sheena Chin, conducted an unannounced Required - 3 year inspection of the Preschool. LPA met with the director, Roopali Born, and explained the purpose of the visit. The Facility is licensed to serve age 2.9 years to entry into kindergarten. Room2 (foothill 2) & room 3 (foothill 3) & adjacent playground. Approved to serve up to 4 non-ambulatory children. In 2019 the Preschool had requested for a waiver for the playground to be used by the preschool program, but the facility had never received the waiver. The director stated that currently the playground was used by both programs, preschool from 9am to 1130am and special education program after 1pm. Hours of operation to serve children: 8:00 AM to 2:15 PM Monday to Friday. Staff working hours: 8:00 AM to 5:00 PM. The director stated that the facility does not have weapons on the premises and that smoking is not allowed on the premises. The director stated that they provided incidental medical services (IMS) but there’s no children who required IMS. The director stated that they provided breakfasts and lunches. Observation LPAs toured the indoor and outdoor areas of the Facility with the director, Poopali Born. Required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule were observed. continue to page 2.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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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: FOOTHILL HEAD START	FACILITY NUMBER: 434415557
	VISIT DATE: 03/18/2024

NARRATIVE

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Observation
The facility had fire inspection on 8/31/23 for adding non-ambulatory. The Fire Marshall came on 1/3/24 for annual fire inspection but the facility was closed for winter break from 12/18/23 to 1/5/24. The Fire Marshall has not yet scheduled the annual fire inspection for 2024. LPA observed fully charged Fire Extinguishers, functioning smoke/carbon monoxide detectors, First Aid Kit, central heating, and air conditioning in all rooms. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Restrooms for children to use were observed to be in operating condition. Play equipment were maintained in a good condition, free of hazards.

The facility provides two meals (Breakfast and Lunch). Meals are prepared and packaged by the outside vender, Kidango, which is off site, and then delivered to the facility. Trash cans for solid waste had tight-fitting covers on. Water fountains observed in the classroom 2 and in the hallway were covered due to the suggestions from the water testing contractor, according to the director. The director stated that children drank water from the pitcher in the classroom and in the playground.

The teacher/child ratio was in compliance during today's inspection. 4 preschool children with two teachers in Room 2, and 12 preschool children with three teachers in Room 3. The director stated that she understands the conditions, limitations, and capacity specifications of the Facility license and that children shall be always supervised within the classroom and in the playground areas.

The playground area utilized by preschool & special education children was surrounded by appropriate fencing. Shade was provided by trees and building in the playground area. The outdoor equipment is age-appropriate and in good condition. Turf surfacing is used as resilient material throughout the playground. There were no bodies of water observed.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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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: FOOTHILL HEAD START	FACILITY NUMBER: 434415557
	VISIT DATE: 03/18/2024

NARRATIVE

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Records review
Disaster drills shall be conducted at least every six months and be maintained for at least one year. The last drills were conducted on 3/8/24.LPA reviewed facility's sign in/out procedure and record.

A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization. Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. S2 and S3 didnot have MMR vaccine records and S2 did not have DTap vaccine record maintained in the files. LPA advised the director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

LPA advised the director 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 facility had conducted water lead test on 10/18/2022 in accordance to the Written Directives outlined in PIN 21-21.1.CCP.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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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: FOOTHILL HEAD START	FACILITY NUMBER: 434415557
	VISIT DATE: 03/18/2024

NARRATIVE

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Discussion
Water lead test: 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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). All centers need to complete the lead testing in accordance to the Written Directives outlined in PIN 21-21.1.CCP. LPA referred the director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

Incidental Medical Services (IMS): This facility provides Incidental Medical Services – IMS, but per Director, currently the facility does not have any children in care who requires IMS. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/.

Deficiency
A regulatory violations was observed during the inspection. A citation was issued.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: FOOTHILL HEAD START	FACILITY NUMBER: 434415557
	VISIT DATE: 03/18/2024

NARRATIVE

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Further questions
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.

Exit
Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with director, Roopali Born.
Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 03/19/2024 11:13 AM - It Cannot Be Edited

Created By: Sheena Chin On 03/18/2024 at 04:03 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: FOOTHILL HEAD START	FACILITY NUMBER: 434415557
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The facility did not maintain MMR records for S2 and S3 and TDap for S2, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/01/2024
	Plan of Correction
1 2 3 4	The director will send LPA the copies of the immunization records for S2 and S3.

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:

Gladys Kuizon

LICENSING EVALUATOR NAME:

Sheena Chin

LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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