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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416303
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:34:11 PM

Document Has Been Signed on 08/07/2024 02:34 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:
434416303
ADMINISTRATOR/
DIRECTOR:		MERAT AYALEWFACILITY TYPE:
830
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
08/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:Merat Ayalew and Dinora SanchezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (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 was the center was cited on 07/25/2024 for teacher qualifications and supervision. Also, to amended the report dated 07/25/2024 to reflect the change to the civil penalty assessed on 07/25/2024 and to assess the civil penalty of $500 for absence of supervision cited on 07/25/2024. Present during the inspection were four infants and at least three staff.

Upon arrival, LPA observed that Licensee was in the preschool yard, then walked over to the infant yard. S-1 and S-2 are not fully qualified infant teachers. S-3 was in the office upon arrival.

Facility submitted proof of purchase of new portable cribs to Licensing on 07/25/2024. S-3 made sheets tight-fitted during today's inspection. LPA also discussed with S-3 that all bottles and food containers brought from home need to have child's name and current date.

As a result of this inspection, a Type A citation was issued. A civil penalty of $1,300 was assessed for failure to correct. 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 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 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 02:34 PM - It Cannot Be Edited


Created By: Samantha Yip On 08/07/2024 at 10:58 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: 434416303

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
101416.2(c)(1)(A)

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Infant Care Teacher Qualifications and Duties. To be a fully qualified infant care teacher, a teacher shall have the following: Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants.
This requirement is not met as evidenced by:
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By POC 08/08/2024, center will submit staff schedule.
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Based on observation and record review, S-1 and S-2 were with the infant children; neither are a fully qualified infant teacher. 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.
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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