434415726-1-17-2023-07-CC-AMOS-CN6MR4-20230117084941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415726
Report Date: 01/13/2023
Date Signed: 01/17/2023 08:49:55 AM

Document Has Been Signed on 01/17/2023 08:49 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GO KIDS @ PASEO		FACILITY NUMBER:	434415726
ADMINISTRATOR:	MAHALAKSHMI CHIVUKULA		FACILITY TYPE:	850
ADDRESS:	1908 SENTER ROAD #80		TELEPHONE:	(408) 947-7149
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 34	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Mahalakshmi Chivukula		TIME COMPLETED:	12:45 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	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 A and B (Preschool Class) 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 #A, 19 children, three staff ( one qualified teacher, one teacher's assistance and one student aide), and in Classroom #B, observed 16 students with three teachers (one qualified teacher, and two teacher's assistance). Facility was observed to be in compliance with teacher to child ratio requirement during visit. A Fully charged, 2A 10BC Fire extinguishers were observed in the front of the classrooms. and in the hallway. The Carbon monoxide detectors are interconnected with the smoke alarms located on the ceilings. Each of the classrooms have refrigerators and 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. Fire Drills are conducted monthly with the last Fire Drill being conducted on 12/14 /2022

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GO KIDS @ PASEO	FACILITY NUMBER: 434415726
	VISIT DATE: 01/13/2023

NARRATIVE

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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. The isolation room is in the main office This facility is not providing Incidental Medical Services – IMS Plan. None of the children currently enrolled are using medication.

LPA reviewed a random 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 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GO KIDS @ PASEO	FACILITY NUMBER: 434415726
	VISIT DATE: 01/13/2023

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In the areas that were evaluated, there were no deficiencies cited. Due to technical difficulties, LPA was unable to leave a copy of this report.

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

DIRECTOR WAS INFORMED TO POST THE NOTICE OF VISIT IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS ONCE SHE RECEIVES THE COPY FROM LPA

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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