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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415566
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:12:01 PM

Document Has Been Signed on 11/17/2022 03:12 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: 44CENSUS: 14DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Rivas-Bejarano, YeseniaTIME COMPLETED:
02:30 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken. This facility is currently licensed for a capacity of 44. Licensing staff met with Director Rivas-Bejarano, Yesenia and Regional Director Valadez, Fabiola and explained the nature of today’s inspection. This is a preschool program that currently operates from 7:00 AM to 6:00 PM, Monday thru Friday. Every second Thursday of each month closes at 1:30 PM. This facility is on WC Overfelt High School Campus.

Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 14 children in care with one Director, and 4 fully qualified teachers.

Physical Plant: All areas identified on the Facility Sketch were inspected. This preschool program which consists of the following classrooms: Toddler Classroom, Young Pre-school Classroom and Pre-school Classroom,

LPA observed the following: Toddler Classroom: There was no staff and no children in care. Per Regional Director due to lack of staffing, there is currently no enrollment in this classroom. Enrollment expected to open in the new year. This classroom serves 18 months to 2.10 years old. Young Pre-school Classroom: There were Staff 2 and 3, fully qualified teachers, with four children in care. This classroom serves children 2.11 to 3.11 years old. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to one classroom sink and one lavatory sink and one toilet, 1/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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
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: 11/17/2022
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Pre-school Classroom: There were two Staff (4 and 5), both fully qualified teachers with ten children in care. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to two classroom sinks, two lavatory sinks (four in total) and two toilets. All classrooms are adjacent to one another, separated by gate/s. Due to staffing breaks and lower attendance, the Young Preschool classroom staff and children are moving to the Preschool area as needed, in order to stay in ratio. All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient have telephone services, heating, lighting, and ventilation.

General sanitization & safety: Each child has their own cubby to store their belongings. Per Director, sick children are isolated in the director's office area. LPA advised Director that all storage containers for solid waste, including moveable trash receptacles must have tight-fitting covers that are kept on, and in standard condition, garbage bins have foot petals to open. There is one bin without a lid used for paper only. One bin with out cover in lavatory was taken out during visit.

Availability of indoor drinking water was observed in classrooms, through filtered water. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care, out of reach and/or locked. Director states that poisons are kept with the custodian. No bodies of water or other hazards were observed during inspection. Director understands that smoking is prohibited. Per Director there are no firearms on site.

Kitchen: There is a kitchen with a gate in a separate area from classroom. All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Water and refrigerator temperatures in standard condition. Director states waste is to be discarded immediately after each meal.

Food: Menus are posted weekly, in classrooms, on parent board, emailed and copies given upon request. Menus for the past one year are available upon request. Facility provides breakfast, lunch and PM snack. 2/7

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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
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: 11/17/2022
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LPA reviewed food for availability, quantity, and appropriateness to children in care. Per Director, all meals are prepared daily at the main center, San Juan Baustista # 430703695 and transported daily to facility. Snacks and supplemental food with 5 components kept on site.

Per Director there are 3 children in care with mild allergies: 1. One Egg. 2. Two Lactose. There is no medication needed for these allergies. There is an allergy list for each child posted in kitchen and classroom area. The list in the classroom has a name only list, per Director if medication is required there is a name to picture passport system. LPA and Director discussed having passport system for all allergies for best practice.

Lavatories: There are two lavatories. Young Preschool: There is one lavatory, one lavatory sink and one toilet. Preschool room: There are two lavatory sinks and two toilets. A total of three lavatory sinks and three toilets in the facility. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, there are 24 children enrolled. LPA and Director discussed when at full capacity, a child will use the staff lavatory. Director states there is always a floater for such situations, in order to keep teacher-child ratio. When enrollment is lower Young Preschool lavatory will be used and promtly disinfected after use.



Outdoor Playgrounds: There are two playgrounds. Toddler playground: This has an area where there is a small concrete wall, that circles around. There is another higher concrete wall attached. LPA has advised that there be fencing between the two drops for best practice. This playground is currently not being used and will not be used until the new year. Director understands for best practice this shall be completed before playground will be used. A work order was done during inspection and a copy was given to LPA.

Preschool Playground: This is separated from the Toddler playground with a fence. All Equipment in both playgrounds are in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. 3/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: 11/17/2022
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All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. There is a mobile sandbox table in the preschool area, covered with a lid when not in use and inspected daily or as needed. Both playgrounds are fully fenced. LPA observed two locked storage shed, extra toys and other play equipment.

Facility Records: LPA/s issued Review of Staff records (LIC 859) to the Director during this inspection. At least one staff (Director) has record of CPR and First Aid, valid until 08/29/2024.All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Director’s training valid thru 04/12/2024. Directors understand this must be renewed every two years. LPA/s reviewed 2 children's files and issued an LIC 857. LPA reviewed 5 staff files total. All files were observed to be complete. LPA and Director discussed sending Director packet in order to update the system. Per Regional Director previous Director is on medical leave.

Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where sign in. Facility uses a paper sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There are no waivers on file.

Medical & First Aid Supplies: There is a first aid kit in classroom, kept in backpacks near the exit. There are extra first aid kits in cabinets. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked monthly or as needed. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. The medication is kept in a locked cabinet or in a locked box in refrigerator if needed and/or in emergency backpack when child/ren outside (at least six feet high) which is stored out of reach of children. LPA and Director discussed that medication must be accessible to staff at all times when children are in care. 4/7

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 11/17/2022
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Per Director there are currently no children enrolled who required Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, per Director the fire department conducted an annual fire inspection on 10/18/2022.There is a Fire extinguisher, size 3A40BC in each room, last serviced 04/20/2022. Last fire drill was conducted on 10/18/2022, Director understands this is to be completed a minimum of every six months.

Matts and cots: Cots inspected for napping were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped daily with a detergent, disinfectant or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and is washed on site daily (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding is stored in individual plastic bags, in a hamper and labelled.



Toddlers: LPAs observed that play yards do not hinder the entrance or exit to and from the space children are to sleeping in. Cots for toddlers were observed to be firm and covered with a fitted sheet that is appropriate to the cot size. Each toddler has their individual bedding and is washed daily or as required. Bedding is replaced when wet or soiled and is placed in an area inaccessible to toddlers. Director was advised that infants shall not be swaddled while in care. 5/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 11/17/2022
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Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and regulations read to the Director during this inspection. LPA reminded Director that staff shall physically check on and document the following: 1. Breathing, Sleep position, signs of distress; specified in Responsibility for Proving care and supervision for infants 101429 of Title 22 for more information. 2. Facility provides potty training, LPA read regulation, Infant Care and Personal Services, 101428, to ensure facility will meet potty training requirements once toddlers are enrolled.

Lead Testing: Director states lead testing has been done on 03/15/2022. There was no lead detected. LPA obtained a copy of the report. LPA and Director discussed the LIC 9275, a completed signed and dated childcare sampling checklist form LIC 9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self-report testing results. Due to COVID 19, Facets outside have been permanently capped off.

LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan. LPA and Director discussed updating relocation site off premises in the event of an emergency, Director completed form and LPA obtained a copy for licensing file. LPA and Director discussed postings to be placed in toddler room, which has a separate entrance, upon re-opening.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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 6/7

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: 11/17/2022
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Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative. AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers


The following was discussed:
· Reporting Requirements. The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations. All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties. All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions. LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There are NO deficiencies being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes. LPA and Director discussed the following: 1. A name to face list of allergies posted. 2. Updated LIC 610, relocation sites. 3. Fence in the concrete drop. 4. Place food in plastic bins in kitchen area. 5. Place an extra trash bin with lid in Young preschool room. 6. Regional Director states there will be a portable sink placed beside a change table in the Young Preschool lavatory. LPA and Regional Director discussed using the change table in the classroom until this is complete 7. Posting in Toddler room. 8. Director packet sent to LPA. Director understands that while facility is currently in compliance, failure to take such measures may result in future citations. LPA may conduct an unannounced case management to inspect the facility for updates.

A notice of site visit was issued and MUST remain posted for 30 consecutive days. Exit interview conducted and report was reviewed with facility representative. 7/7
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7