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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416687
Report Date: 07/14/2022
Date Signed: 07/15/2022 08:06:06 AM

Document Has Been Signed on 07/15/2022 08:06 AM - 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:HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOLFACILITY NUMBER:
434416687
ADMINISTRATOR:JESSICA WATTSFACILITY TYPE:
850
ADDRESS:8455 WREN AVENUETELEPHONE:
(408) 413-2111
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 38DATE:
07/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Jessica WattsTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other. LPA met with Site Director Jessica Watts and explained the reason for the inspection. Present during today's inspection were 38 children and at least 4 staff.

Based on facility roster dated 07/13/2022, S-1 had a Closed- Determination Closed status on fingerprints. S-1's fingerprints were transferred to the facility on 09/22/2021. LPA discussed with Site Director that they are checking their facility roster to determine that all transfer request are transferred to facility and cleared.

S-2 completed Livescan on 06/29/2022. There was an error on the facility number. S-2's fingerprints are not yet requested and not associated to facility. S-2 started working at the facility on 07/05/2022. Site Director understands that new hires need to have cleared fingerprints and associated to facility prior to initial presence in the facility. LPA also discussed with Site Director about checking on Guardians or calling the San Jose Regional office to ensure any transfer request or new hires have cleared fingerprints and are associated to facility. Site Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

----------------------------continues on 809 dated 07/14/2022 page 2-------------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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 07/15/2022 08:06 AM - It Cannot Be Edited


Created By: Samantha Yip On 07/14/2022 at 03:30 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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 434416687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2022
Section Cited
CCR
101170(e)(1)

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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 or
This is requirement is not met as evident by:
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By POC 07/15/2022, Site Director stated that she will submit paperwork for S-2 and understands that S-2 cannot be at the facility until fingerprints are cleared and associated.
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Based on record review, S-2 completed livescan on 06/29/2022; however, facility number was entered incorrectly. S-2's fingerprints are not cleared and associated to facility, which 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: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 434416687
VISIT DATE: 07/14/2022
NARRATIVE
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---------------------------continuation of 809 dated 07/14/2022 page 1-------------------------------

LPA Samantha Yip informed Site Director Jessica Watts that this report dated 07/14/2022 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 Site Director to provide a copy of this licensing report dated 07/14/2022 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.

As a result of this inspection, one Type A citation and one technical violation was issued. A civil penalty of $500 was assessed for caregiver background check. Exit interview conducted and report was reviewed with the Director, Jessica Watts. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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