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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416989
Report Date: 06/01/2023
Date Signed: 06/05/2023 08:22:40 AM

Document Has Been Signed on 06/05/2023 08:22 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: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: 18DATE:
06/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Blanca HernadezTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA ) conducted a Case Management to hand deliver an Amended report that was written on 5/9/2023 and to review POC's (Plan of Corrections) for deficiencies that were cited on 05/09/2023. Present during today's inspection was Director Blanca Hernandez.

LPA observed a total of 18 children: Classroom 1, two teachers and 8 children, Classroom 2, two teachers and 10 children.

The facility was issued a "Type A" deficiency on 05/09/2023 for Limitations on Capacity:101161(a). The Plan of Correction was due on 05/10/2023. The Facility was, also, issued a "Type B" deficiency for Health-Related Services: 101126(a)(2). The Plan of Correction is due on 6/6/2023.

The Director submitted all the POC's(plan of corrections) LPA, also, observed that the Acknowledge of Receipt of Licensing Reports were signed by the parents of children in care and kept in each child's records. LPA observed the Notice of Site Visit, LIC 809 & LIC809D reports which were issued 05/09/2023 posted on wall next to the facility entrance door.
LPA concludes that the the facility has completed its required plan of corrections and the deficiencies are thus cleared as of today's visit. LPA advised Director Blanca Hernandez that a schedule informal meeting may be held at the San Jose Regional office to discuss the deficiency(s).
No deficiency was cited for this visit. A notice of site visit was given and must remain posted for thirty days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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