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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416304
Report Date: 08/07/2024
Date Signed: 08/07/2024 01:51:07 PM

Document Has Been Signed on 08/07/2024 01:51 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: 22CENSUS: 17DATE:
08/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Merat Ayalew & Dinora SanchezTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and Samantha Yip met with Licensee, Merat Ayalew, and Site Director, Dinora Sanchez, for a Plan of Correction (POC) inspection. LPAs toured the facility and reviewed files. LPAs observed S1 alone supervising 12 school age children in the playground. S1 does not have fingerprint clearances and no transcripts on file. Five additional children arrived during the inspection.

At approximately 10:34 AM, LPA Yip observed five school age children in the classroom unsupervised by staff when S2 left the classroom and walked towards the front door of the sanctuary while the other staff (S3) was supervising the children in the bathroom. Per record review, S2 and S3 are aides.

As a result of this inspection, Type A deficiencies were cited on the following pages.

Assembly Bill (AB) 633 was provided and discussed with Site Director. LPAs informed the Site Director to provide a copy of this licensing report dated 08/07/24 that documents Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of any newly enrolled children for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224) must be placed in the children's files for verification.

Exit interview conducted and report was reviewed with Site Director, Dinora Sanchez.

A Notice of Site Visit was issued and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
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 01:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 08/07/2024 at 10:52 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: 434416304

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
101170(e)(1)

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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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By POC due date: 08/08/24, facility will submit a written plan on how they will ensure that staff are fingerprint cleared prior to working with the children.
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This requirement is not met as evidenced by: S1 does not have fingerprint clearances and was left alone supervising 12 school age children in the playground. This poses an immediate risk to the health, safety and personal rights of children in care.
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A civil penalty of $500 was assessed.
Type A
08/08/2024
Section Cited
CCR101516.5(b)(1)

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Teacher-Child Ratio. A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.
This requirement is not met as evidenced by:
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By POC due date: 08/08/24, facility will submit a written plan on how they will ensure that unqualified staff are not left alone with children.
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Based on observation, the school age children were supervised by unqualified staff. S1, S2 and S3 are aides. This poses an immediate risk to the health, safety, and personal rights of children in care.
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The facility was cited on 07/25/24 for violating 101516.5(b)(1). Because the facility failed to make the correction on the date specified: 07/26/24, a civil penalty of $100 per day is hereby assessed for the period of 07/27/24 through 08/07/24, a total of $1200.
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:Marilou Monico
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 01:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 08/07/2024 at 11:34 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: 434416304

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
101229(a)(1)

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Responsibility for Providing Care and Supervision - (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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By POC due date: 08/08/24, the facility will submit a detailed plan on how staff will maintain adequate supervision of children at all times.
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This requirement was not met as evidenced by: Based on observation, five school age were left unsupervised in the classroom. This poses an immediate risk to the health, safety, and personal rights of children in care.
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An immediate civil penalty of $500 was assessed.

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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:Marilou Monico
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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