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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416304
Report Date: 07/18/2024
Date Signed: 07/25/2024 05:01:42 PM

Document Has Been Signed on 07/25/2024 05:01 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:
434416304
ADMINISTRATOR/
DIRECTOR:		MERAT AYALEWFACILITY TYPE:
840
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 21DATE:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:Telma Rojas and Merat AyalewTIME VISIT/
INSPECTION COMPLETED:
09:59 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Other inspection. LPA met with Telma Rojas and explained the reason for the inspection. The purpose of this inspection is to discuss outdoor activity space, limitation of license, and volunteer requirements.

Upon arrival of the facility, LPA observed that there were school-age children playing in the grass area that is next to the preschool and in-between the parking lots. Area is not fenced off nor on their license. Facility has a waiver to use the preschool yard. LPA observed that there was a child who ran to a car that was parked on the side of the grass area, then back.

LPA also observed that facility had a volunteer, who is a high school student, present at the center. Volunteer is present for more than 16 hours a week. LPA discussed with Director and Licensee that they cannot volunteer for more than 16 hours a week and the facility has an agreement with the educational institution concerning the placement of the student. The volunteer cannot be left alone with children. LPA observed at 3:25PM that the volunteer was left alone with two children.

Facility is using a room in the church building, which is not on the license. It was measured during the pre-licensing inspection. An updated license will be mailed to facility. Facility will submit updated facility sketch.

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 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: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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 07/25/2024 05:02 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/25/2024 08:34 AM


Created By: Samantha Yip On 07/18/2024 at 04:34 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416304

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
101170(b)(4)(D)

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Criminal Record Clearance. A student who is enrolled or participating at an accredited educational institution if all of the following apply: The student is not left alone with the children in care.
This requirement is not met as evidenced by:
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By 07/19/2024, facility will submit plan outlining how they will ensure volunteers are supervised by a staff who has cleared criminal
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Based on observation, at 3:25PM, LPA observed that the volunteer was left alone with two school-age children, which poses an immediate health and safety risk to children in care.
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record clearance and not left alone.
Type A
07/19/2024
Section Cited
CCR101161(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 07/19/2024, facility will seize using the area.
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Based on observation, LPA observed that the school-age children were using the grass area and patio area in front of the church and that is in-between the parking lots. Area is not licensed under the school-age license. 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: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/18/2024 07:32 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/18/2024 at 04:42 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: 434416304

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
101238.2(g)

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Outdoor Activity Space. The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.
This requirement is not met as evidenced by:
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By 07/25/2024, facility understands that if they want to use that area that a fence needs to be installed and an inspect will need to be
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Based on observation, LPA observed that grass area and patio area that school-age children were using was not fenced. This poses a potential health and safety to children in care.
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conducted prior to use. An updated faciltiy sketch needs to also be submitted.
Type B
07/25/2024
Section Cited
CCR1011709(b)(4)(C)

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Criminal Record Clearance. The student spends no more than 16 hours per week at the facility.
This requirement is not met as evidenced by:
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By POC 07/25/2024, facility will submit written statement and agreement that volunteer will not be present more than 16 hours per week.
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Based on interview, volunteer spends more than 16 hours per week at the facility, which poses a potential health and safety.
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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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