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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415786
Report Date: 05/24/2023
Date Signed: 05/24/2023 07:01:37 PM

Document Has Been Signed on 05/24/2023 07:01 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:FOOTSTEPS PRESCHOOLFACILITY NUMBER:
434415786
ADMINISTRATOR:RACHEL RATLIFFFACILITY TYPE:
850
ADDRESS:8335 CHURCH STREETTELEPHONE:
(408) 842-7269
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 26DATE:
05/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Lisa SernaTIME COMPLETED:
07:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with staff, Lisa Serna, and explained the reason for the inspection. Present during today's inspection were 26 children and at least four staff.

The hours of operation are Monday through Friday 7AM to 6PM. There is a working phone at the center. LPA reviewed the sign in/sign out sheet.

LPA toured the inside and outside of the center with Lisa. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. LPA observed that there containers of disinfectant wipes under the bathroom sinks for children and a bag with a roll of disinfectant wipes under the bathroom sinks located near the 2 years old classroom. There was a tube of diaper cream under changing table. Lisa removed the wipes and diaper cream during inspection and placed it in an off-limit area. There are toys and equipment for children. The floor were free of tripping hazards. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was on 10/28/2022. Lisa stated that there are no weapons, such as firearms, stored on the premise.

The outdoor area is fenced. Shaded rest area is provided through tree, building overhang, and umbrellas. Play structure were observed to be in good condition. LPA observed that resilient material was low. There were no bodies of water observed during today's inspection.
------------------------continues on 809 dated 05/24/2023 page 2------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FOOTSTEPS PRESCHOOL
FACILITY NUMBER: 434415786
VISIT DATE: 05/24/2023
NARRATIVE
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------------------continuation of 809 dated 05/24/2023 page 1----------------------

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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.

Seven (7) staff files were reviewed during today's inspection. The records reviewed include but not limited education credit and Health Screening. LPA observed that 3 out of seven staff did not have health screening on file. Lisa has a valid CPR/1st Aid, which expires on 01/29/2025.

LPA observed that there a staff that was standing outside of the bathrooms next to the chapel. There were children in both the girls and boys restroom. Staff went back from each bathroom. LPA discussed with Lisa that there needs to be a staff positioned where they can visually supervise children at all times, including when they are in the bathroom. An additional staff came and stood outside of the other restroom during today's inspection. There was a staff standing at each restroom where they can visually supervise children in the restroom.

LPA observed that center is using the chapel as a napping room. Chapel was included in the facility sketch submitted during the initial application. LPA checked with the Fire Marshal to ensure that it was part of the approved fire clearance.

LPA discussed with Lisa that the center needs to designate her to be responsible if the Director is not present.

As a result of this inspection, type B citations were issued. Exit interview was conducted and report was reviewed with Lisa Serna. A notice of site visit has been issued and must remain posted for 30 days.

Staff, Lisa Serna, was informed that the Annual Inspection will continue and be completed at a later date.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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Page: 2 of 5
Document Has Been Signed on 05/24/2023 07:01 PM - It Cannot Be Edited


Created By: Samantha Yip On 05/24/2023 at 05:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FOOTSTEPS PRESCHOOL
FACILITY NUMBER: 434415786

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed that there was not enough resilient material around the play structure.
POC Due Date: 05/31/2023
Plan of Correction
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By POC 05/31/2023, center will send proof that additional resilient material is being obtained.
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed that facility is using both restroom for children. There were only one staff outside. Staff cannot see children in both restroom. Staff was walking back and forth from both restrooms.
POC Due Date: 05/31/2023
Plan of Correction
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By 05/31/2023, center will submit written plan on how they will ensure that children are visually supervised at all time in the restroom.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/24/2023 07:01 PM - It Cannot Be Edited


Created By: Samantha Yip On 05/24/2023 at 05:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FOOTSTEPS PRESCHOOL
FACILITY NUMBER: 434415786

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in three out of eight persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2023
Plan of Correction
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By POC 05/31/2023, center will send proof that appointments for staff to complete the health screening and TB test. Center will send a copy of health screening and tb test to Licensing once obtained.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of seven persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2023
Plan of Correction
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By POC 05/31/2023, center will have staff fill out and sign LIC 9052 and send a copy to Licensing.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


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Document Has Been Signed on 05/24/2023 07:01 PM - It Cannot Be Edited


Created By: Samantha Yip On 05/24/2023 at 06:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FOOTSTEPS PRESCHOOL
FACILITY NUMBER: 434415786

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
101161(a)
Limitations on Capacity. A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited, which poses an immediate health, safety or personal rights risk to persons in care. LPA observed that the center is using the chapel as the nap room. Center is only licensed for Room 2, 3 and 4.
POC Due Date: 05/25/2023
Plan of Correction
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By POC 05/25/2023, center will seize using the chapel. Facility understands that they need to obtain fire clearance and get approval from Licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
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