Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703758
Report Date: 04/12/2019
Date Signed 04/12/2019 04:31:09 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:SANTA TERESA CHILDREN'S CENTERFACILITY NUMBER:
430703758
ADMINISTRATOR:JERRIE CALDERONFACILITY TYPE:
850
ADDRESS:6150 SNELL AVENUETELEPHONE:
(408) 928-5270
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:24CENSUS: 2DATE:
04/12/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Tersie NdonTIME COMPLETED:
04:40 PM
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
Licensing Program Analyst (LPA), Shannel Reed arrived to the facility to conduct an unannounced annual/ required inspection. LPA met with Site Supervisor, Tersi Ndon, and informed her of the purpose of today’s inspection. LPA observed 2 children present. LPA toured the Facility both inside and outside. Operation hours for the program are 7:30AM to 4:30M, Monday through Friday. LPA observed all the required posted materials.
LPA reviewed five (5) children's files and all have the required documentation.

LPA Reed reviewed the three staff files and found that each have the required documentation. Ms. Ndon’s CPR/ First Aide certification that expires on 11/14/19. Each teacher has the required immunization's against Pertussis, Measles and Influenza. Each teacher has completed the Required Mandated Reporter Training for Child Care Providers (AB1207) from an Alternative course provided by ESUHSD and Keenan Safe Schools.

The rooms are clean and safe. The children's bathroom is sanitary and operable. The center provides AM/ PM snack and lunch. Lunch id brought by the on site school cafeteria and prepared in the off limits kitchen. Drinking water is readily available for the children indoor via water fountains. The Site Supervisor states that there are no weapons or firearms on the premises. There is at least one functioning smoke and carbon monoxide detector at the facility. The last Fire Drill was conducted on 03/14/19.

The playground area is surrounded with appropriate fencing. There is sufficient resilient material surrounding the slides and climbing equipment. Drinking water outdoor is available via water fountain. LPA observed that the surface of the outdoor activity space is in safe condition and free of hazards.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 04/12/19):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SANTA TERESA CHILDREN'S CENTER
FACILITY NUMBER: 430703758
VISIT DATE: 04/12/2019
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
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 04/12/19):
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication equipment /supplies and reviewed children’s personnel records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS was 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)/ (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.html

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Facility staff can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.

No Title 22 deficiencies cited during today’s inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2