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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415726
Report Date: 02/07/2022
Date Signed: 02/08/2022 08:10:44 AM

Document Has Been Signed on 02/08/2022 08:10 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:ESTRELLA FAMILY SERVICES @ PASEOFACILITY NUMBER:
434415726
ADMINISTRATOR:MAHALAKSHMI CHIVUKULAFACILITY TYPE:
850
ADDRESS:1908 SENTER AVENUE #80TELEPHONE:
(408) 947-7149
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 22DATE:
02/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Mahalakshmi ChivukulaTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Anna Morales conducted an ANNUAL REQUIRED visit and was met by Site Director Mahalakshmi Chivukula. Hours of operation is Monday through Friday, 7:00am to 4:00pm. LPA toured the indoor and outdoor areas of the Facility during today's inspection. LPA notes that the Facility is licensed in Preschool Rooms 1 and 2. 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 site is located within an apartment complex. The playground is located and fenced on the right side of the entrance. The tenants of the apartment complex do not have access to the playground or preschool.

LPA observed in Classroom #1, 15 napping students with two qualified teachers, and in Classroom #2, observed 15 napping students with two teachers. Facility was observed to be in compliance with teacher to child ratio requirement during visit.

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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2021
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: ESTRELLA FAMILY SERVICES @ PASEO
FACILITY NUMBER: 434415726
VISIT DATE: 02/07/2022
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Two Fully charged Fire extinguishers were observed ( one in the hallway, close to Classroom #1 and one in Classroom #2) The smoke detectors detectors are interconnected with the smoke alarms located on the ceilings. Carbon monoxide detector observed. Observed cubbies for personal storage. Disinfectants and toxics materials are stored inaccessible to the children. Observed trash bins with tight fitted lids. Each of the classrooms have first aid kits LPA was informed that the parents use a electronic sign in and sign out. The isolation room is in the main office until parent pick up. This facility is t providing Incidental Medical Services – IMS Plan. None of the children currently enrolled are using medication.

LPA observed fully fenced playground area. Observed climbing structures and with materials that observe falls. Shade is provided by a canopy. The children use there own water bottles, and water is also provided by the school. Playground is age appropriate.. The center provides breakfast, lunch and an afternoon snack for the children.

LPA reviewed a random selection of children files. Children records reviewed include , Identification and Emergency Contact, Medical Assessment and Immunization

LPA reviewed a selection of Staff records reviewed include Health Screening Report and TB test, and Immunization (Measles, Pertussis, and Flu) record and current Mandated Reporter Training. LPA reminded Licensee that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA reminded Licensee for 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.
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SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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: ESTRELLA FAMILY SERVICES @ PASEO
FACILITY NUMBER: 434415726
VISIT DATE: 02/07/2022
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LPA also reviewed with Licensee for the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

LPA discussed the requirements of AB 633 with the Licensee. The Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

A copy of this report was provided to the facility at the conclusion of the inspection. In the areas that were evaluated, there were no deficiencies cited.


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



NOTICE OF SITE VISIT WAS ISSUED. LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
LIC809 (FAS) - (06/04)
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