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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416302
Report Date: 07/18/2024
Date Signed: 07/18/2024 07:35:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240710171210
FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416302
ADMINISTRATOR:MERAT AYALEWFACILITY TYPE:
850
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:38CENSUS: 31DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Telma Rojas and Merat AyalewTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Out of Ratio
Children are commingling
Facility has insects and/or rodents
Children's personal rights are violated
Children left unsupervised
Facility is not clean, safe, sanitary, and in good repair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPA met with Director Telma Rojas and Licensee Merat Ayalew and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation and inspected the physical plant. LPA also interviewed children and staff. Based on the information obtained, the above allegations are found to be SUBSTANTIATED, meaning the preponderance of the evidence standard has been met.
------------------continues on 9099 dated 07/18/2024 page 2--------------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
VISIT DATE: 07/18/2024
NARRATIVE
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-------------------continuation of 9099 dated 07/18/2024 page 1--------------------

Based on observation, facility was not within ratio during today's inspection. At 9:43AM, LPA observed that there was one staff (S-1) with 14 children in Room 2 (Pre-K Room). LPA also observed at 10:24AM that S-1 with 14 children. S-1 opened the door leading to the Room 1 (Panda Room) leaving 14 children in the room with a therapist, who is not associated to facility. At 10:31AM, LPA observed that a staff (S-2) walked out of the office to Room 2. At 11:53AM, LPA observed that S-2 with 16 children. A staff walked into the room at 11:54AM. S-2 does not have any proof of completion of courses on file. LPA discussed with Licensee that the ratio if there is a fully qualified teacher is 12 and if there is one fully qualified teacher and an aide with no units that they can only supervise 15 children.

Based on interview, the school-age children commingling with the preschool children.

LPA observed that a staff grabbed a child by the wrist and had them sit down on a chair. LPA also observed that a child told to sit down from 10:29AM till 10:37AM. LPA discussed with Director that time-out can only be a minute per age of child.

Based on inspection of the physical plant, LPA observed that there is a metal cabinet that is outside of Room 1 that has mouse dropping inside and on the floor to the right of cabinet.

At 10:01AM, LPA observed that a staff brought children to the restroom. There were some children sitting down outside of the restroom and some in the restroom. LPA observed that the staff went the window and was talking to a parent. Staff was unable to visually supervise children in the restroom. LPA also observed at 10:46AM that there were two children in the restroom. There was no staff positioned where they can visually supervise the children in the restroom.

LPA observed that there were plastic bins in Room 1 that was cracked and used for toys. LPA also observed that the wooden play structure on the left hand side was missing a wooden plank on the top causing there to be a gap in the floor. There is also a plastic play structure that is cracked. Area that is cracked is sharp. LPA also observed that the tarp outside is coming up, which could cause a tripping hazard. LPA also observed that there is another wooden play structure on the right side of the yard. There is ladder that is on the upper level, which one side is not anchored. The ladder does move when pushed on.

--------------------continues on 9099 dated 07/18/2024 page 3-------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
VISIT DATE: 07/18/2024
NARRATIVE
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----------------continuation of 9099 dated 07/18/2024 page 2------------------------

As a result of this inspection, Type A and Type B citations were issued. Exit interview conducted and report was reviewed with Director Telma Rojas. A notice of site visit has been issued.

LPA Samantha Yip informed Director Telma Rojas that this report dated 07/18/2024 documents four Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director to provide a copy of this licensing report dated 07/18/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
101216.3(a)
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Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.
This requirement is not met as evidenced by:
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By POC 07/19/2024, facility will submit written plan outlining how they will ensure faciltiy is within ratio and submit staffing schedule.
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Based on observation, LPA observed that one staff was with 14 children at 9:43AM and 10:24AM. LPA observed at 10:31AM that staff left 14 children with therapist. At 11:54AM, LPA observed that there was one staff with 16 children. This poses an immediate health and safety risk to children in care.
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Type A
07/19/2024
Section Cited
CCR
101161(a)
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Limitations on Capacity. A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evidenced by:
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By POC 07/19/2024, facility will submit written plan how they will ensure the school-age children and preschool children do not commingle.
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Based on interview, the school-age children and preschool children commingling. This poses an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time...
This requirement is not met as evidenced by:
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By POC 07/19/2024, facility will submit written plan on how they will ensure children are supervised at all times.
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Based on observation, LPA observed at 10:01AM and 10:46AM that there were children in the restroom. There was no staff positioned where they can visually supervise the children. LPA also observed at 3:05PM that there was a child in Room 2. The staff was standing by the hallway that leads to the restroom. This poses an immediate health and safety risk to children.
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Type A
07/19/2024
Section Cited
CCR
101223(a)(3)
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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by:
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By POC 07/19/2024, facility will submit written plan on how they will ensure children's personal rights are not violated.
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Based on observation, LPA observed that a staff grabbed a child by the wrist and had them sit down on a chair. LPA also observed that a child told to sit down for 10:29AM till 10:37AM. This poses an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2024
Section Cited
CCR
101238(a)(1)
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Buildings and Grounds. The licensee shall take measures to keep the center free of flies, other insects, and rodents.
This requirement is not met as evidenced by:
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By POC 07/25/2024, facility will submit plan how they will ensure center is free of rodents.
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Based on observation, there is a metal cabinet that is outside of Room 1 that has mouse dropping inside and on the floor to the right of cabinet. This poses a potential health and safety risk to children in care.
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Type B
07/25/2024
Section Cited
CCR
101238(a)
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Building and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by:
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By POC 07/25/2024, facility will submit proof that plastic bin is removed, wooden play structure is fixed, and plastic playstructure is either fixed or
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Based on observation, there were plastic bins in Room 1 that was cracked and used for toys. LPA also observed that the wooden play structure on the left hand side was missing a wooden plank on the top causing there to be a gap in the floor. There is also a plastic play structure that is cracked. Area that is cracked is sharp. LPA also observed that the tarp outside is coming up, which could cause a tripping hazard. This poses a potential health and safety risk to children in care.
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removed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7