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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416989
Report Date: 10/28/2022
Date Signed: 10/28/2022 04:25:38 PM

Document Has Been Signed on 10/28/2022 04:25 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:EMC2 KIDS ACADEMYFACILITY NUMBER:
434416989
ADMINISTRATOR:BLANCA HERNANDEZFACILITY TYPE:
850
ADDRESS:4953 STEVENS CREEK BOULEVARDTELEPHONE:
(408) 409-5901
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 10DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Blanca HernandezTIME COMPLETED:
04:30 PM
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Licensing Program Analyst ( LPA) Anna Morales conducted an unannounced Annual Required inspection. LPA met with Licensee Blanca Hernandez at today's inspection. Facility's License, Notification of Parents’ Rights Poster, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 9:00-6:00pm. Age served is 2 years to entry into Kindergarten. Last disaster drill was conducted in October 3, 2022

The Preschool Program is operating in two classrooms. Classroom Number One is for the toddler classroom;2-3 year olds. LPA observed five children and one teacher and one teacher's assistant. In Classroom Number two, LPA observed five preschool aged children and one teacher. LPA toured the facility both indoor.. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Fire extinguisher, smoke and carbon monoxide detectors were observed. There were no bodies of water observed. Licensee stated that the facility does not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. Activities schedule and Menu were posted. Facility does not provide lunch but does provides two snacks (morning and afternoon). LPA observed that food storage areas were clean and free of litter.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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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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: EMC2 KIDS ACADEMY
FACILITY NUMBER: 434416989
VISIT DATE: 10/28/2022
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This facility is providing Incidental Medical Services – IMS Plan. Licensee stated there is an isolation area for sick children to wait for parent pick-up. Licensee also stated that there are no children who are taking medications. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ)toll-free ADA Information Line at (800)514-0301(voice)/(800)514-0383 (TYY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/chidlqanda.htm

LPA reviewed a random selection of children files. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, Immunization.

LPA reviewed Staff's records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPA reminded Licensee that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA also 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.

LPA discussed the requirements of AB 633 and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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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: EMC2 KIDS ACADEMY
FACILITY NUMBER: 434416989
VISIT DATE: 10/28/2022
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Exit interview conducted and report was reviewed with the California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC 809-D. Appeal Rights Given.

A copy of this report was provided to the facility at the conclusion of the inspection.



NOTICE OF SITE VISIT WAS ISSUED. BLANCA HERNANDEZ WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE CENTER FOR A PERIOD OF 30 DAYS.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2022 04:25 PM - It Cannot Be Edited


Created By: Anna Morales On 10/28/2022 at 03:46 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: EMC2 KIDS ACADEMY
FACILITY NUMBER: 434416989

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the Child Care Center does not have a qualified Director present.which poses/posed a potential health, safety or personal rights risk to persons in care. Blanca Hernandez stated that she is in the process of obtaining supporting documentation to hire as the new Director.
POC Due Date: 11/11/2022
Plan of Correction
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Licensee shall submit full documentation for an assigned new Director to Licensing Department by November 11, 2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022


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