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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416175
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:17:17 PM

Document Has Been Signed on 05/08/2024 02:17 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:SJB - JAMES LICK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416175
ADMINISTRATOR/
DIRECTOR:		SABRINA FENECHFACILITY TYPE:
850
ADDRESS:57 NORTH WHITE ROADTELEPHONE:
(408) 928-5221
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 32DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Sabrina FenechTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 5/8/24 LPA Sheena Chin conducted an unannounced Case Management - Incident inspection to the facility in response to an incident that occurred on 5/2/2024. LPA met with the director, Sabrina Fenech and explained the purpose of the visit.

The facility reported that the child, C1, was choked on chips during snack time on 5/2/24. Staff conducted back blows to the child, who then spit out the chips from mouth. Parents were notified the incident and Unusual Incident Report was filed to the Licensing Department. The director stated that the food, including the snack came from the SJB’s central kitchen. The directed stated that assistant prepared the food and teachers served the food to kids. LPA observed that the snacks listed on the menu on 5/2/24 were Whole Grain Corn Tortilla Triangles, Salsa, Celery sticks and water. LPA reviewed the child’s file, which did not show special medical needs or food restrictions.

No regulatory violations were observed during today's inspection.

Exit interview was conducted, and the report was reviewed with the director, Sabrina Fenech.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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