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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416303
Report Date: 07/18/2024
Date Signed: 07/18/2024 07:31:07 PM

Document Has Been Signed on 07/18/2024 07:31 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:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:31 PM
MET WITH:Telma RojasTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Director Telma Rojas and explained the reason for the inspection. Licensee Merat Ayalew left the facility at 955AM. The purpose of this inspection is to discuss teacher qualification, napping equipment, safe sleep, and criminal background check.

During today's inspection, LPA observed that S-1 and S-2 were in the infant room. S-1 has transcript on file, but it does not show completion of at least 3 semester units in infant care. S-2 does not have any transcript on file. S-1 has cleared criminal record clearance, but fingerprints were not transferred to facility.

LPA also observed that the sheets on the playyards were not tight-fitted. LPA discussed with Director regarding safe sleep and that sheets on the playyard need to be tight-fitted.

As a result of this inspection, Type A and Type B citations were issued. A civil penalty of $500 for caregiver background check was issued. Exit interview conducted and report was reviewed with Director Telma Rojas. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Director Telma Rojas that this report dated 07/18/2024 documents two 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
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 07/18/2024 07:31 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/18/2024 at 01:28 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416303

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
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 07/19/2024, Director will submit staffing plan and schedule how she will ensure that there is at least one fully qualified infant teacher.
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Based on record review, S-1 and S-2 do not have proof of completion of 3 semester units in care of infants. This poses an immediate health and safety risk to children in care.
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Type A
07/19/2024
Section Cited
CCR101170(e)(2)

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Criminal Record Clearance. Request a transfer of a criminal record clearance as specified in Section 101170(f).
This requirement is not met as evidenced by:
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Director submitted LIC 9182 during today's inspection.
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Based on record review, S-1 has cleared criminal record clearance, but fingerprints were no transferred to facility. 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: 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


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/18/2024 07:31 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/18/2024 at 01:51 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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416303

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
101439.1(b)(1)

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Infant Care Center Sleeping Equipment. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress...
This requirement is not met as evidenced by:
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By POC 07/25/2024, facility will show proof that sheets are tight fitted.
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Based on observation, LPA observed that the sheets in the playyard are not tight-fitted. 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: 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


LIC809 (FAS) - (06/04)
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