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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417149
Report Date: 02/11/2025
Date Signed: 02/11/2025 12:26:23 PM

Document Has Been Signed on 02/11/2025 12:26 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:EARLY HORIZONS PRESCHOOLFACILITY NUMBER:
434417149
ADMINISTRATOR/
DIRECTOR:		STEFANIE ALAMOFACILITY TYPE:
860
ADDRESS:1510 LEWISTON DRIVETELEPHONE:
(408) 746-3020
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 213TOTAL ENROLLED CHILDREN: 178CENSUS: 118DATE:
02/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:Stefanie Alamo, Kylee Nguyen and Antonio LabradorTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mandeep Kaur conducted a Case Management-Incident inspection, that was self-reported on 02/04/2025. LPA met with Site Director, Stefanie Alamo, Licensee representative, Kylee Nguyen and Enrollment Director, Antonio Labrador. LPA interviewed one staff (S1) and Enrollment Director during today's inspection. LPA reviewed one child (C1) file and four(4) staff pediatric CPR/First aid certifications.

Enrollment Director stated that incident happened on 02/03/2025 around 04:52pm, at where a child (C1) fell backwards, hitting the back of their head on the concrete outside in the play area. Based on interviews, after the child (C1) was brought back inside the classroom Pre-K2 by a staff (S1), a child's(C1) eyes were rolling back, lips were purple, more drooling and Enrollment Director was notified by a Staff (S5) to go inside the classroom Pre-K2. Upon entering, Enrollment Director access the child and when child started shivering, 911 call was made at 04:59PM by Enrollment Director.

Enrollment Director stated that re-training on recognizing the early signs of illness and the need for professional assistant, will be provided by sending out the staff memo via email, during teacher learning day and another Pediatric CPR/First aid training.

As a result of this inspection, Type B citation was issued on attached page: 809-D. Appeal rights provided.

Exit interview conducted and report was reviewed with Enrollment Director, Antonio Labrador. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 02/11/2025 12:26 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 02/11/2025 at 11:41 AM
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: EARLY HORIZONS PRESCHOOL
FACILITY NUMBER: 434417149

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/25/2025
Section Cited
CCR
101216(e)(5)

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Personnel Requirements: (e) All personnel shall be given on-the-job training in the areas listed below, or shall have related experience that demonstrates knowledge of and skill in those areas. Such training or experience shall be appropriate to the job assigned and shall be evidenced by safe and effective job performance. (5) Recognition of early signs of illness and the need for professional assistance.

This requirement was not met as evidenced by:
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Licensee will submit the copy of the staff memo and detailed training notes on recognizing the early signs of illness and need for professional assistance to the department.
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Based on interviews, a child's (C1) hit the back of his head, was brought inside the classroom by a staff(S1): Pre-K2, his eyes were rolling back, lips were purple, more drooling, enrollement director was notified and 911 call was made at 04:59pm by enrollent director after accessing the child, which posed potential health, safety or personal rights risk to persons 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:Belinda Devall
LICENSING EVALUATOR NAME:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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