434416693-3-21-2024-07-CC-FRAA-D3KMVU-20240321095721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416693
Report Date: 03/20/2024
Date Signed: 03/21/2024 09:57:26 AM

Document Has Been Signed on 03/21/2024 09:57 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LITTLE OAK PRESCHOOL		FACILITY NUMBER:	434416693
ADMINISTRATOR:	JENNIFER POTMESIL		FACILITY TYPE:	850
ADDRESS:	1921 CLARINDA WAY		TELEPHONE:	(408) 369-1252
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 145	TOTAL ENROLLED CHILDREN: 98	CENSUS: 87	DATE:	03/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jennifer Potmesil		TIME COMPLETED:	04:20 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), Farida Raja, met with Director, Jennifer Potmesil for an unannounced annual inspection in the Preschool Program. The facility is licensed to serve children from 2- entry into first grade in 8 rooms. Facility has an infant program (#434416695) at the same location. LPA observed the required posted materials in the office area. Emergency Disaster Plans (LIC 610), Menu, lesson plans and class schedules were posted in each classroom. Days and hours of operation are Monday through Friday, 8:00 am to 5:00 pm. LPA and Director toured the indoor and outdoor areas of the Infant Program during today's inspection and observed the following ratios: Room 30 (Red Birds): 11 children and 2 teachers Room 31 (Blue Birds): 11 children and 2 teachers Room 32 (Hummingbirds): 10 children and 2 teachers Room 33 (science and Library Room)- no children present. Room 6 (Green Frogs): 14 children and 2 teachers Room 7 (Yellow Ducks): 16 children and 2 teachers Room 22 (Brown Bears): 10 children and 2 teachers Room 29 (Polar Bears): 13 children and 3 teachers Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, kitchen and office area were inspected. Children were having lunch with help from teachers during today's inspection. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408-369-1252). Disinfectants, cleaning products, sharp items and medicines were stored inaccessible to the children in care. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE OAK PRESCHOOL	FACILITY NUMBER: 434416693
	VISIT DATE: 03/20/2024

NARRATIVE

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Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed solid waste containers with tight-fitting lids in the rooms. LPA observed appropriate changing tables that have raised sides (3 inches in height) and have vinyl changing pads that are at least 1 inch thick in younger classrooms. LPA observed a trash can with tight fitting cover for the disposal of diapers. Napping equipment (mats/cribs) is appropriate. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom that can be utilized by sick children if needed. Sick children are isolated in the Director's office and isolation equipment is provided. There is a separate bathroom for sick children located in Room 11. There are two staff bathrooms at the facility located in the office area. Staff and children's bathrooms are clean, sanitary, and operable.

First aid supplies are stored in each classroom and in the office area. Cleaning supplies are stored in the high cabinets in each room out of reach of children. LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 03/19/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles which are refilled using a pitcher filled with filtered store bought water. Facility provides morning and afternoon snack that are prepared in the kitchen and director stated that no water outlets are used for drinking or food preparation purposes. Director stated that they have always had water delivered since the opening of the facility. LPA asked Director to submit a written attestation stating that they exclusively use a delivery service to provided filtered water and no outlets at the facility are used for drinking water and food preparation purposes including for washing dishes or fruit/vegetables. Director posted signage near the kitchen sink that states that it cannot be used for food preparation purposes during today's inspection. LPA asked Director to submit a facility sketch indicating all water outlets as well.

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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE OAK PRESCHOOL	FACILITY NUMBER: 434416693
	VISIT DATE: 03/20/2024

NARRATIVE

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Facility provides morning and afternoon snack and lunch provided by parents. Menu was observed to be posted in each classroom and in the office area. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. LPA observed an allergy list posted on the refrigerator in each classroom.

LPA observed outdoor play area surrounded by appropriate fencing and the outdoor surfaces are safe. Shade is provided by trees, canopies, and building overhang. LPA observed tanbank and sand as resilient material under and around climbing structures and swings. No bodies of water were observed. LPA discussed with Director about plans for obtaining more tan bark and having staff even out tan bark before children go outside. LPA informed Director that staff need to position themselves so that children are supervised at all times while outdoors.

Children sign in and out logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed eight (8) children’s files during today's inspection. Each child's file reviewed contained the required forms.

Four (4) staff files were reviewed. All teachers and staff maintain valid background clearances. All staff files reviewed contain the required transcripts/verification of experience. All staff files reviewed have current CPR and First Aid certification on file. All staff have the required immunization's against pertussis, measles and influenza (or statement declining the immunization). LPA observed required Mandated Reporter Training on file for all staff.

Director 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE OAK PRESCHOOL	FACILITY NUMBER: 434416693
	VISIT DATE: 03/20/2024

NARRATIVE

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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. Facility has an approved IMS Plan on file with San Jose Regional Office. Medications are stored in each classroom out of reach of children. On review, LPA observed that child C1 has two parental consent forms for prescription medication but has one non prescription medication that is expired and does not have parental consent form. 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/.

Facility does not provide transportation to children. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

One technical violation was cited today. Exit interview was conducted with Director, Jennifer Potmesil.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC809 (FAS) - (06/04)

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