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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415566
Report Date: 10/01/2021
Date Signed: 10/01/2021 03:53:53 PM

Document Has Been Signed on 10/01/2021 03:53 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:SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434415566
ADMINISTRATOR:PATRICE KELLEYFACILITY TYPE:
850
ADDRESS:1835 CUNNINGHAM AVENUETELEPHONE:
(408) 928-5260
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 44TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
10/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Patrice KelleyTIME COMPLETED:
04:20 PM
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Licensing Program Analysts (LPA) Janette Cruz met with Patrice Kelley, Director, for an unannounced Required - 1 year inspection. LPA toured the Facility (indoor and outdoor areas) during today's inspection. LPA notes that the Facility is licensed in the following rooms: 8 toddler Option in Toddler room and 36 preschool in Preschool and Young Preschool room. LPA observed the 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. The facility has no active waivers on file.

LPA reviewed ten children's and five staff files (1 director, 2 teachers and 2 teacher aide ) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and medical assessment. Sign in and sign out sheets were reviewed and were in compliance, including legal signatures. All staff files reviewed contain the required transcripts/verification of experience/immunization records (including flu vaccine opt out forms) and Health Screening Report (LIC 501). All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. LPA reviewed that all staff present have current CPR and First Aid certifications on file. Director understands 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 (field trips).

LPA observed that the teacher/child ratio was in compliance during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. Director states that the Facility has adequate cleaning/sanitizing supplies & PPE equipment.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2):
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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 3
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: SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415566
VISIT DATE: 10/01/2021
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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Director states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Director understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment are in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water dispensers. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises. The Facility has working smoke and carbon monoxide detectors.

LPA observed that the food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in locked cabinets/high shelves inaccessible to children. Director states that there are no poisons in the Facility. Director states that the Facility does not administer medication at this time.

LPA observed two playgrounds are separate, age appropriate and surrounded by appropriate fencing. There is a play structure in each playground. The area around and under the play structure has rubber surfacing. There is shade in the outdoor space available for rest area. LPA did not observe any bodies of water during today's inspection. Transportation will not be provided by this facility.

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3):
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415566
VISIT DATE: 10/01/2021
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A review of staff records on 10/01/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.


LPA conducted an exit interview with the Director prior to the conclusion of today's inspection and advised her that no deficiencies are issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED AND POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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