Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413597
Report Date: 06/29/2016
Date Signed 06/29/2016 03:52:51 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: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: 44DATE:
06/29/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Stacy SilveyTIME COMPLETED:
01:00 PM
NARRATIVE
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Unannounced random visit made by Analyst Jean Walton. Met with Director Stacy Silvey.

There are no bodies of water on the property.
Ms. Silvey states there are no weapons at the Preschool.
Cleaning supplies are stored inaccessible to children.
There are no medications at the Preschool for any of the children.
Furniture and equipment appears in acceptable condition.
Children's bathrooms are in operating condition. The vinyl covered pads on the changing tables and the tops of the diaper genies are white and look discolored. These items need to be cleaned.
Floors appear clean.
Kitchen appears clean. All food was covered.
Trash cans for food waste have tight-fitting covers.
Playground and large classroom have drinking fountains. Bottled water is used in smaller classrooms.
Playground has a sand box, grass, and cement areas. Rubber matting is used for cushioning material under the climbing structure.
No flies, insects, or rodents were observed.
Staff have clearances associated to the Preschool.
Children were supervised during the visit.
Children have emergency information at the Preschool.
Menu is posted and snacks are served.
Several staff need copies of official transcripts.

See next page for deficiencies cited today.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Jean WaltonTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2016
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: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL
FACILITY NUMBER: 434413597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2016
Section Cited
101238(a)
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BUILDINGS AND GROUNDS - The child care center shall be clean, safe, sanitary, and in good repair at all times to ensure the safety and well-being of children, employees, and visitors. The vinyl pads on the changing tables and the tops of the diaper genies are discolored and need to be cleaned.
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Ms. Silvey states the pads on the changing tables and the tops of the diaper genies will be cleaned by 7/13/16.
Type B
07/13/2016
Section Cited
101216.1(g)
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TEACHER QUALIFICATIONS AND DUTIES - A photocopy of the teacher's Child Development Permit or a photocopy of the teacher's transcripts documenting successful completion of required course work, shall be maintained at the Center. Several Teachers do not have photocopies of their official transcripts at the Center.
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Ms. Silvey will have the Teachers bring copies of the official transcripts to the Center by 7/13/16.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Jean WaltonTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2016
LIC809 (FAS) - (06/04)
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