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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417157
Report Date: 06/12/2024
Date Signed: 06/12/2024 11:44:36 AM

Document Has Been Signed on 06/12/2024 11:44 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CYPRESS CHRISTIAN ACADEMYFACILITY NUMBER:
434417157
ADMINISTRATOR/
DIRECTOR:
MARY SUSANNA TALATHOTIFACILITY TYPE:
860
ADDRESS:460 CYPRESS AVENUETELEPHONE:
(408) 597-4975
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Mary Susanna TalatothiTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 06/12/2024 Licensing Program Analysts (LPAs) Harsimran Kaur and Janette Cruz met with Applicant representative, Mary Susanna Talathoti. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure that health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. There were no children present during this inspection. This is an application for a preschool license with capacity of 34 children, ages 2 to 6 years old. The child care center will operate on the following days: Mondays to Friday from 8:00 AM - 06:00 PM. Facility is located in a church site, Christ Church of India. The fire clearance was approved on 05/08/24.

LPAs toured and measured the on-limits areas and classrooms located at the facility.

Classroom measurements are:

The Indoor total measurements contain a total of 1213.43 square feet, which will accommodate Applicant’s request for 34 children.

Outdoor Play measurements are:

Outdoor total measurements contain a total of 8841.58 square feet, which will accommodate Applicant’s request for 34 children.

Indoor/Children’s Area:

The facility was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. All outdoor and indoor passage ways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All play equipment and materials used by children were observed to be age appropriate. There are 35 chairs, 9 tables, 36 cubbies, 3 toilets, and 3 sinks for the preschool program. The Applicant shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CYPRESS CHRISTIAN ACADEMY
FACILITY NUMBER: 434417157
VISIT DATE: 06/12/2024
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The Applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on. LPAs observed no fireplace or open face heaters. Snacks will be provided by facility. LPAs observed a kitchen area that shall be made inaccessible to children at all times. The facility has fridge and microwave. All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Drinking water is readily available for the children in the facility via purified water drinking dispensers.

LPAs observed a fully equipped first aid kit located in all classrooms. A separate staff bathroom is available. Applicant stated that any child who becomes ill during the day shall be isolated in the facility office. The isolation area shall be equipped with a mat, cot, couch or bed for each ill child. The Applicant shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted. Applicant was reminded that all child care centers shall have working telephone service on the premises.


Outdoor:

LPAs observed outdoor area for preschool children were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. The playground is enclosed by a fencing at least 4 feet high. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a play structure which is properly anchored. There is adequate resilient material (wood chips) that can absorb a fall. LPAs observed no bodies of water. Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. LPAs observed an air conditioner condenser unit by the shaded playground area that is accessible to children. LPAs advised Applicant that A/C condenser unit should be covered or barricaded for children's safety.



Health Related Services:

Medications shall be kept in a safe place inaccessible to children. A refrigerator shall be used to store any medication that requires refrigeration.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CYPRESS CHRISTIAN ACADEMY
FACILITY NUMBER: 434417157
VISIT DATE: 06/12/2024
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The following items were discussed:

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPAs discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPAs also informed Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.



Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

LPAs advised Applicant that smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b). All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition. LPAs observed hot and cold water available. Hand washing fixtures shall not be required to deliver hot water. Applicant stated that facility will not have transportation arrangements for children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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, available at: http://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CYPRESS CHRISTIAN ACADEMY
FACILITY NUMBER: 434417157
VISIT DATE: 06/12/2024
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LPAs reviewed with Applicant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant was informed of the MyChildCarePlan.org site, 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..

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following correction is needed prior to the issuance of a license.


1. Submit proof of photo that a/c condenser unit located in outdoor play area is barricaded and made inaccessible to children.

An exit interview was conducted and copy of appeal rights was provided to Mary Susanna Talatothi, Applicant. Final license determination for a single license will be made upon review by the Licensing Program Manager.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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