430700114-2-3-2021-07-CC-AALZ-BXVVTG-20210203154306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700114
Report Date: 02/03/2021
Date Signed: 02/03/2021 03:44:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE		FACILITY NUMBER:	430700114
ADMINISTRATOR:	LAURA ARUTA		FACILITY TYPE:	850
ADDRESS:	5303 CARTER AVENUE		TELEPHONE:	(408) 265-3580
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	60	CENSUS: 24	DATE:	02/03/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Sayre, Rachel		TIME COMPLETED:	11:27 AM

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	On this day, Licensing Program Manager (LPM) Segura, Mary and Licensing Program Analyst (LPA) Almaraz, Celi conducted a televisit with Director Sayre, Rachel via zoom, due to COVID19 and social distancing guidelines. The purpose of this visit was to discuss a violation that took place on 12/11/2020. The informal office meeting was initiated by LPM Segura to further discuss the self reported unusual incident, reported to duty on 12/11/2020, and submitted to our office on 12/14/2020. The following was discussed in today's meeting: A child was left unsupervised on the play ground, in a play tunnel on the play structure. The informal meeting was held as the result of this incident. Civil penalties in the amount of $500.00 were assessed on 01/29/2021 with a Type A deficiency, that was cited for supervision violation 101229(a)(1). The deficiency was cited in accordance with California Code of Regulations Title 22. Director Sayre shall ensure that children in care are supervised at all times. LPM Segura further explained the administrative process and advised that continued non-compliance with Title 22 Regulations, may result in a referral to our legal department for review and possible disciplinary action against the license. Assembly Bill 633 (Child Care Parent Notification Requirements) and Acknowledgement of Receipt of Licensing Reports (LIC9224) also explained. The director submitted a plan of correction on 01/29/2021, that included the training of staff on supervision and updated facility protocols for transition times, staff break times, the counting of children and stop signs being placed on all doors to give a visual reminder to count children. Staff/teacher break or meal times will not occur during student/child transition times or recess times. In addition, the director has been conducting unannounced spot checks to the classrooms and playground areas, to ensure that teachers are following the updated facility protocols for transitions and staff breaks/meal times.:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCARE	FACILITY NUMBER: 430700114
	VISIT DATE: 02/03/2021

NARRATIVE

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The director, Rachel Sayre has agreed to also do the following to ensure staff/teachers are providing required supervision of children in care:

1. The Director will keep a journal documenting her observations her spot checks of staff/teachers. The documentation shall include any guidance or training provided by the director if protocols were not followed . Spot checks will be unannounced and occur at least twice weekly. The journal will be made available for review by Department staff upon request.

2. Teachers/staff will verbally confirm with each other the child/student count at times of transition and when relieving each other for breaks or meal times. Staff will sign statements that they understand and will follow this updated protocol. Director will submit signed staff acknowledgment of new procedure by close of business, 02/04/2021 if any staff is currently not working, they shall compete this, upon first day of return to work, close of business.

3. The Director shall inform staff/teachers in writing of any known changes in behavior and/or development of children that would affect the level of supervision necessary for that child(ren). This information shall be shared with all staff/teachers who provide direct care and supervision to that child(ren) in a timely manner. Staff/teachers shall acknowledge receipt of updated information about child behavior or development in writing. This documentation shall be made available to Department staff upon request.

The Director understands that Community Care Licensing will increase monitoring of the facility for the next twelve months to ensure that adequate supervision of children is happening and that the facility is in substantial compliance with licensing regulations.

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

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SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

LIC809 (FAS) - (06/04)

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