434416425-2-8-2024-07-CC-CNEN-D29SBV-20240208124433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416425
Report Date: 02/08/2024
Date Signed: 02/08/2024 12:44:42 PM

Document Has Been Signed on 02/08/2024 12:44 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:	KINGDOM KREW PRESCHOOL		FACILITY NUMBER:	434416425
ADMINISTRATOR:	JESSICA ALICE CAMP		FACILITY TYPE:	850
ADDRESS:	1730 CURTNER AVENUE		TELEPHONE:	(408) 264-2811
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 10	CENSUS: 4	DATE:	02/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Jessica Camp		TIME COMPLETED:	12:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Jessica Camp, for an unannounced Required- 3 Year Inspection. LPA was granted access to the facility by staff member, Lynell, and toured both indoors and outdoors during the inspection. Upon arrival, there were four (4) preschool-age children and two (2) staff members (one teacher/Site Director) present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 8:00AM-6:00PM. LPA reviewed sign-in/out, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. The facility has submitted a waiver request for digital sign-in/out that uses a Personal Individualized Number (PIN) for authorized representatives to use upon pick-up and drop-off. LPA advised that the waiver request is under review and the approved waiver will be mailed to the facility. The last fire/disaster drill was conducted on 1/11/2024, which is compliant with the six-month requirement. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 7/2023), built in fire detection system that is annually checked by the Fire Department, and functioning carbon monoxide detector. The Site Director states that she currently has one child in care who requires medication, however no children currently require Incidental Medical Services, such as EpiPens or Inhalers. LPA observed that the medication is properly stored out of reach of children, with the proper documentation. There are no weapons or firearms on the premises. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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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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: KINGDOM KREW PRESCHOOL	FACILITY NUMBER: 434416425
	VISIT DATE: 02/08/2024

NARRATIVE

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Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. The preschool program utilizes classrooms 1A, 1B, and has an approved waiver for occasional use of room 14. LPA observed sufficient age-appropriate materials, toys, and play equipment in the classrooms. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children via Brita water dispensers and water bottles are brought from home, labeled with the children’s names. The children’s bathroom is clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child could use if necessary. There is a working telephone in the facility.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. The facility completed water lead testing with CA Rural Water Association on 9/11/2023 and no Action Level Exceedances were found.

The outdoor area was inspected and observed to be fenced in. There is a playground, plastic structures, tables, and trucks/cars for the children to play with. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. The Site Director states that the playground is checked by staff in the morning and tanbark is raked as needed to maintain its level in areas such as under slides. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by large trees and building overhang currently and the Site Director states that additional canopies and tarps are placed outside during the summer.

The facility offers a full day program and provides AM/PM snack to the children. Lunches are brought from home. The menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA observed the menu is current and has designated portion sizes next to it for reference. The snack storage area is clean and the equipment necessary for the preparation and service of food is well maintained, clean, and sanitized after each use.

Five (5) children's files and five (5) staff files were reviewed and all required documents were present. LPA advised that Site Directors shall complete the Department (CCLD) Operations and Record keeping Orientation within 90 days of hire and maintain certificate of completion. The Site Director has current CPR/First-Aid that expires 11/2024 and current Mandated Reporter Training that expires on 9/23/2025. LPA reminded that the Mandated Reporter training must be renewed by all staff every 2 years.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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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: KINGDOM KREW PRESCHOOL	FACILITY NUMBER: 434416425
	VISIT DATE: 02/08/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Site Director understands that she shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded that there shall be at least one person with valid CPR and First-Aid certifications on site at all times or present during off site activities, such as field trips.

Exit interview conducted and report was reviewed with the Site Director, Jessica Camp.

As a result of today’s inspection, a deficiency was cited, see LIC809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/08/2024 12:44 PM - It Cannot Be Edited

Created By: Cortney Nelson On 02/08/2024 at 12:10 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: KINGDOM KREW PRESCHOOL	FACILITY NUMBER: 434416425
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.05(c)

1597.05 Licensing reviews; health and safety consideration; completion of records; verification (c) Within 90 days of employing a facility director, a licensee shall secure verification that the facility director has completed an orientation given by the Department and shall maintain a copy of that verification. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as the Site Director has not completed the Department Operations and Recordkeeping Orientation, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/16/2024
	Plan of Correction
1 2 3 4	The Site Director, Jessica, shall complete the CCLD orientation and submit certificate of completion to the Department by 2/16/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Cortney Nelson

LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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