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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415594
Report Date: 01/14/2025
Date Signed: 01/14/2025 12:52:26 PM

Document Has Been Signed on 01/14/2025 12:52 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PRECIOUS MOMENTS PRESCHOOL LLCFACILITY NUMBER:
434415594
ADMINISTRATOR/
DIRECTOR:
THUONG LEFACILITY TYPE:
850
ADDRESS:830 WEST EVELYN AVENUETELEPHONE:
(408) 685-2261
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 30TOTAL ENROLLED CHILDREN: 26CENSUS: 23DATE:
01/14/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Priyanka BansalTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Priyanka Bansal, Licensee representative, for an unannounced Required- 3 Year inspection. LPA toured the indoor and outdoor areas of the Facility during today's inspection. 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. Days and hours of operation are Monday through Friday 8:00 AM to 5:30 PM. The Facility is licensed to serve a maximum of thirty preschool children ages 18 months to six years of age in the Orange & Green Rooms (preschool) and Toddler Room (toddlers).

LPA reviewed five children's and four staff files (director and 3 teachers) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and all required licensing forms. All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. All staff have current CPR and First Aid certifications on file. Priyanka understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during outdoor activities. Sign and sign out sheets are in compliance. Last fire/disaster drill was completed

LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed one fully qualified teacher with 7 preschool children in the Green Room, Director with 8 preschool children in the Orange Room, and one fully qualified teacher & one aide with 8 children in the Toddler Room during today's inspection. Priyanka understands the conditions, limitations, and capacity specifications of the Facility license. Priyanka 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: PRECIOUS MOMENTS PRESCHOOL LLC
FACILITY NUMBER: 434415594
VISIT DATE: 01/14/2025
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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Priyanka understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in two separate areas of the inside the facility. Staff and children's bathrooms are clean, sanitary, and in working order. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Priyanka states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors indoors.

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 a food preparation area in the toddler room with a toaster, refillable water gallon dispenser for water bottles that children bring to the facility. There is also a hot and cold running water, sinks, a refrigerator and microwave on the premises. The Facility provides snacks and lunches for the children. The Facility has trash cans with tight fitting lids for solid waste within the Facility. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Priyanka states that there are no poisons in the Facility. LPA observed a complete First Aid kit, including touch less thermometer, in the Facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by trees and building overhang in the playground. There is sufficient resilient materials (rubber flooring) in the outdoor playground area. LPA did not observe any bodies of water. Priyanka states that the Facility does not provide transportation.

Licensee representative, Priyanka Bansal, was reminded that all adults 18 and over living or working in the home, 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 licensed 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: PRECIOUS MOMENTS PRESCHOOL LLC
FACILITY NUMBER: 434415594
VISIT DATE: 01/14/2025
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This facility is not providing Incidental Medical Services – IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. Laura states that the Facility does not administer any medication at this time.

Priyanka Bansal, Licensee representative, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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


Exit interview conducted and report was reviewed with the Licensee representative, Priyanka Bansal.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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