Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413597
Report Date: 09/25/2015 12:00:00 AM
Date Signed 09/25/2015 10:20:42 AM

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:HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOLFACILITY NUMBER:
434413597
ADMINISTRATOR:STACY E. SILVEYFACILITY TYPE:
850
ADDRESS:400 LLEWELLYN AVENUETELEPHONE:
(408) 412-8823
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:70CENSUS: 28DATE:
09/25/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Stacy SilveyTIME COMPLETED:
10:30 AM
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3) LPA Esther Adeyemi met with Site Director Stacy Silvey for an unannounced random visit. Analyst toured the facility building and grounds. A review of staff records during today's visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Stacy understands that all adults that work with the children must have a clearance associated to the facility before they can be present.
Facility Review:
No bodies of water. Stacy stated there are no weapons at the center.
Medications are kept in the office inaccessible to children
Furniture and equipment is age appropriate and in good condition free of sharp, loose or pointed parts.
Children's bathroom appears in safe and sanitary operating condition.
Floors appear clean and safe. Trash can for food waste has a tight-fitting lid.
Snack menu posted and appropriate. Children bring their lunch.
Kitchen, food preparation and storage areas are clean. All food was in covered containers.
No flies, insects or rodents were observed during the visit.
Playground has rubber chips for cushioning material under the climbing structures and surrounding area.
Children were supervised during the visit. Children were signed in/out by parents/authorized representatives with their full legal signature and record the time.
Children's files have identification & emergency information. Staff files have copies of transcripts.
Observed CPR & First Aid for at least one staff person present.

No deficiencies cited during the visit. Center is in Compliance with CA Code of Regulations, Title 22.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Esther AdeyemiTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2015
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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