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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416302
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:43:44 PM

Document Has Been Signed on 08/07/2024 02:43 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:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416302
ADMINISTRATOR/
DIRECTOR:		MERAT AYALEWFACILITY TYPE:
850
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 26DATE:
08/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:01 PM
MET WITH:Merat Ayalew and Dinora SanchezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Samantha Yip and Marilou Monico conducted an unannounced Plan of Correction (POC) inspection. LPA met with Licensee Merat Ayalew and explained the reason for the inspection. The purpose of this inspection is facility was cited on 07/25/2024 for supervision and personal rights. Also, go over the amended report dated 07/25/2024 and to assess the civil penalties for supervision on 07/18/2024 and 07/25/2024. Upon arrival, there 18 children and at least four staff.

During today's inspection, LPAs conducted observation and reviewed staff files. Facility submitted plan of correction to Licensing on 07/26/2024 and stated that staff will conducted training on personal rights.

LPA observed that S-1 and S-2 were in Room 2 with 6 children. S-1 has an evaluated transcript on file, but it does not have semester or quarter units and is missing child/family/community. S-2 does not have transcript on file.

At 9:38AM, Room 2 had 10 children, S-1, S-2, S-3 and A-1. A-1 was observed teaching children. S-3 stated that she is in the process of interviewing A-1. LPA Monico informed S-3 that A-1 cannot be with the children if she is not fingerprint cleared or fingerprints were transferred. S-3 had A-1 leave the room during inspection.

At 10:41AM and 10:42AM, LPA observed that there were children washing their hands in the sink in the restroom. There was no staff positioned where they can visually supervise children in the restroom. S-4 was standing by the tables in Room 2. S-4 then moved to the restroom where they can visually supervise children.

LPAs also observed that the restroom for children only has one toilet and one urinal. Licensee stated that she will use the women's restroom that is outside for the preschool children. The women's restroom has two toilets and two sinks. Licensee understands that the school-age and preschool program cannot share a restroom. Licensee stated that there is a boys and girls restroom in the church for the school-age children. Facility will submit an updated LIC 999A that reflects the change to the restroom.

As a result of this inspection, a Type A and Type B citation were issued. A civil penalty of $250 was assessed for repeat violation and $2,500 for repeat violation. Exit interview conducted and report was reviewed with facility representative, Dinora Sanchez. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed facility representative, Dinora Sanchez, that this report dated 08/07/2024 documents one Type A citations 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 facility representative to provide a copy of this licensing report dated 08/07/2024 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: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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Document Has Been Signed on 08/07/2024 02:43 PM - It Cannot Be Edited


Created By: Samantha Yip On 08/07/2024 at 11:24 AM
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2024
Section Cited
CCR
101216.1(c)(1)

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Teacher Qualifications and Duties. To be a fully qualified teacher, a teacher shall have one of the following: Twelve post-secondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.
This requirement is not met as evidenced by:
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By POC 08/08/2024, center will submit staff schedule and indicate which room each staff will be in.
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Based on record review and observation, S-1 and S-2 were in Room 1. S-1's transcript was evaluated, but does not have the amount of semester units on it.
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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.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/07/2024 02:43 PM - It Cannot Be Edited


Created By: Samantha Yip On 08/07/2024 at 11:33 AM
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2024
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,... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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By POC 08/14/2024, facility submit written plan outlining how they will ensure children are supervised at all time.
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Based on observation, LPA observed at 10:41AM and 10:42AM that children were using the sink in the restroom. Staff were not positioned where they can visually supervise children in the restroom. S-4 moved to the restroom during inspection. This poses a potential 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.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


LIC809 (FAS) - (06/04)
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