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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415730
Report Date: 03/08/2023
Date Signed: 03/08/2023 05:05:05 PM

Document Has Been Signed on 03/08/2023 05:05 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ESTRELLA FAMILY SERVICES @ GARDNERFACILITY NUMBER:
434415730
ADMINISTRATOR:KRISTINE NGUYENFACILITY TYPE:
840
ADDRESS:611 WILLIS AVENUETELEPHONE:
(408) 269-7827
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 56TOTAL ENROLLED CHILDREN: 49CENSUS: 29DATE:
03/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kristine NguyenTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Kassandra Medrano conducted a random annual licensing inspection today. LPA met with Kristine Nguyen, Director, the purpose of the visit was explained. Facility is located on functioning public school site, Gardner Elementary. Analyst inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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. The program operates 7am-8am and 2pm-6pm, Monday- Friday. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Food Service, Transportation, Parents Rights, and Reporting Requirements. Bathrooms for school age children are located within classrooms. The outdoor play area is located out front of classrooms. Children are signed in to the facility by staff for after school care and by parents when dropped off by parents in the morning. They are all signed out of the facility by parent/guardian. Posting requirements for site visits were discussed as well as AB 633 requirements. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov. Staff immunization are on file. Director was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Influenza Declarations were also reviewed. LPA reviewed with DIthe LIC 311A, Records To Be Maintained At facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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: ESTRELLA FAMILY SERVICES @ GARDNER
FACILITY NUMBER: 434415730
VISIT DATE: 03/08/2023
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Director was advised of the required annual pesticides training. For More information about changes to the Healthy Schools Act, templates, or articles, you can inspect the DPR website at:
https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm . Director was informed about the Provider Information Notices (PINs) on CCLD website. Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years. This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.

Exit interview conducted and report was reviewed with the director, Kristine.


"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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