state of california-health and human … · community care licensing san jose regional office 2580...

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Wil l UGHlBOORNE OIRECTOR

March 05, 2014

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF SOCIAL SERVICES 2580 N FIRST STREET, STE. 300

SAN JOSE, CA 95131

CHALLENG~R SCHOOL- 434400459 721 EAST GISH ROAD SAN JOSE, CA 95112

Dear Mr. Mounteer:

EOMUNO G. BROWN JR. GOVERNOO

Your letter dated February 3, 2014, appealing a citation issued on January 30, 2014 for failing to have two staffs criminal record clearance associated to your facility has been received and reviewed. You submitted copies of the initial criminal record transfer requests that you had faxed to the department on August 23, 2011 and August 30, 2012 as part of your appeal.

The Results are as follows: [X] Citation for section 101170(e)(2) is dismissed.

March 5 2014 DATE OF THE REVIEW DECISION

Explanation: Licensing report dated January 30, 2014, the licensing regulations, your licensing file and the documents you submitted have been reviewed. A review of the documents you submitted found that you had faxed transfer requests to the department on August 23, 2011 and August 30, 2012 for the two staff in question. Based on this evidence it has been determined that you had made a good faith effort to comply with the regulations and therefore the citation is being dismissed. As this was a type A deficiency that has now been deemed invalid you are not required to provide a copy of the licensing report dated January 30, 2014 to new parents per AB 633. In the future, please review and return the LIS 555 that is sent to your facility annually to ensure that all staff are associated to any of yo facilities they are working at to avoid citations in the future.

MARY SEGURA Licensing Program Manager (408) 324-2152

February 3, 2014

Ms. Mary Segura Licensing Program Manager Community Care Licensing San Jose Regional Office 2580 North First Street, Suite 300 San Jose, CA 95131

RE: Appeal to Type A Deficiency during Licensing visit

Dear Ms. Segura,

We wish to appeal Community Care Licensing's citation for a Type A regulatory violation during a site visit on January 30, 2014.

Licensing Program Analyst Barbara Walker conducted an unannounced random 5-year visit to our Almaden facility (434400459). During her visit Ms. Walker cited us for a Type A deficiency because she found two cleared staff members who had not been transferred to the facility from other Challenger facilities.

During the visit Preschool Program Director Ms. Geeta Matani provided Ms. Walker with copies of the original transfer requests and the fax transaction reports showing that Challenger had indeed faxed LIC 9182 forms for both Mallory Powers and Blanca Rodriguez to the local Regional Office before they had begun work at the Almaden campus.

Each year we also faxed to Roya Shahkarami, the LPA for this facility previously, an updated Personnel Report (LIC 500) and transfer requests for any new employees. In 2011 there were five transferred employees which included Ms. Powers and Ms. Rodriguez. Copies of all five previously faxed transfer requests were sent to CCL along with the updated LIC 500.

Ms. Walker acknowledged that it was possible that our fax copies were indeed received by the Licensing office but the system was not updated because they are short staffed and no one necessarily looks at those reports.

We have been advised in the past that the requirement to submit a transfer request to our local Regional Office before an employee may begin work or be present in the facility is met when we fax the LIC 9182 to the local office. We understand that the procedures have now changed and we must also send a hard copy ofthe LIC 9182 to the Regional Office in addition to faxing a copy.

We followed the instructions we had been given at the time the two employees in question were transferred to our Almaden campus and believed that we had done everything necessary to transfer their background clearances properly.

The Facility Evaluation Report also states that we must "ensure that prints are transferred and cleared prior to employment" however the Department of Social Services website's Background Check Process page states:

"All clearance transfer requests must be submitted to the Department before the individual, who is subject to the transfer, has cl ient contact or the licensee will be in violation of the law and subject to a $100 civil penalty per day per violation. An individual need not wait for a confirmation of the transfer before he/she can begin work or be present in the facility."

In accordance with this statement it has been our understanding that we do not need to wait for the local Regional Office to confirm that they have processed the transfer request through their system before our employee may begin working at the new facility.

As required we review, update, and return to CCL a corrected facility roster along with any backup paperwork when they are sent to us by Licensing.

Challenger School believes that we did everything required by our LPA at the time to request that both Blanca Rodriguez and Mallory Powers' background clearances be associated with our Almaden campus and also keep them associated with the facility from which they were transferring.

We respectfully request a formal review by the licensing agency and removal of the citation of deficiency from our facility record. We further request that the requirement that we provide a copy of Facility Evaluation Report dated 1-30-14 to all parents for one year be dismissed.

We also request permission to remove your department 's "Notice of Site Visit" posting that indicates our facility was shown to have regulatory violations issued during your visit and be replaced with a clean notice.

Si*l,t Dave Motmteer Executive Region Director Challenger School

Enclosures

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

02/12/2014

CHALLENGER SCHOOL 434400459 721 EAST GISH ROAD SAN JOSE, CA 9511 2

Letter of Deficiency Citations Cleared Dear Licensee,

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

The fol lowing deficiencies, in itially cited during a visit on 01 /30/2014, have been cleared:

Section Cited: 1 01 170(e)(2) Date Due: 02/03/201 4 Plan of Correction: Corrections: Director to send transfer requests to CCL (Completed at time of visit.), and submit a written plan on how center will ensure that prints are transferred and cleared prior to employment.

Received written plan. POC cleared . Clearance Date: 02/03/2014

AB 633 states upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months and it is to be signed and kept in each child 's file .

LICENSING EVALUATOR NAME: Barbara Walker TELEPHONE: 408-334-8553

DATE: 02/12/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - (04/05) Page: 1 of 1

February G. 2014

Barbara Walker Department of Social Services Community Care Licensing 2580 N. First Street, Suite 300, !VIS: 29-08 San Jose, CA 95131

RE: Plan of Correction for Facility Evaluation Report- Almaden Campus, San Jose (434400459)

Dear Ms. Walker:

We are hereby submitting this revised letter as our plan of cotTection as required by your report dated January 30, 2014 in which we were cited for a Type A deficiency relating to cleared staff whom your office did not show as associated with our Almaden facility.

In order to ensure that all employees who work within our licensed child care facilities arc properly associated with a particular facility we will do the following:

l. We will continue our practice of not hiring anyone until /unless we have received the proper applicant fingerprint response fi·om the Califomia DOJ.

2. We will continue to fax Criminal Background Clearance Transfer Request torms (LIC 9182) and proof of identity to the appropriate Community Care Licensing Regional Office before a current employee begins work at another of our facilities to which they have not previously been associated.

3. We wil l now, as instructed during this licensing visit, send via U.S. Postal Service copies of the Criminal Background Clearance Transfer Request forms (LIC 9182) and proof of identity that were fa.xed to the CCL Regional Office directly to the CCL Regional Oflice.

If our understanding of the new procedure is incorrect or insufficient in any way please contact us immediately so that we may correct our procedures. Challenger School has always taken great pride in operating our facilities in compliance with all regulatory statutes and believes that we have done so in this situation as well.

If you need anything further from us, or should there be any questions, please cont.aci me at the Challenger School Region Offioe. at at~ 40 -377-2300 or by email at pmQ_\l!l!~I@£ballengerschool.com

Sine~, ~ Dave Mounteer Executive Region Director Challenger School

721 East Gish Road San Jose, CA 95008 (408) 377-2300

, ...

Walker, Barbara JB.@DSS

From: Sent: To: Cc: Subject: Attachments:

Ms. Walker,

Tag art, Mary < [email protected] > Monday, February 03, 2014 2:29 PM Walker, Barbara JB.@DSS Mounteer, Dave; Huang, Lois; Matani, Geeta; Taplin, Melanie Plan of Correction for Challenger School Almaden campus 434400459 Plan of Correction for Challenger School Almaden campus 434400459.pdf

Please find attached our Plan of Correction in connection with your Facility Evaluation Report of our Almaden campus campus dated January 30, 2014.

Mary Tagart Executive Administrative Assistant Challenger School

1

Walker, Barbara JB.@DSS

From: Sent: To: Cc: Subject: Attachments:

Good morning Ms. Walker,

Tagart, Mary <[email protected] > Friday, February 07, 2014 9:11 AM Walker, Barbara JB.@ DSS Mounteer, Dave; Huang, Lois; Matani, Geeta; Taplin, Melanie RE: Plan of Correction for Challenger School Almaden campus 434400459 REVISED Plan of Correction for Challenger Almaden.pdf

Per your request, please find attached our revised Plan of Correction. We have changed item #3 as requested to say that we will send a copy of LIC 9182 forms to the CCL Regional Office, but not to the attention of a specific LPA.

Thank you,

Mary Tagart

Executive Administrative Assistant Challenger School

-----Original Message-----

From: Walker, Barbara JB.@DSS [mailto:[email protected]] Sent: Tuesday, February 04, 2014 12:27 PM To: Tagart, Mary

Cc: Mounteer, Dave; Huang, Lois; Matani, Geeta; Taplin, Melanie Subject: RE : Plan of Correction for Challenger School Almaden campus 434400459

Hello Mary,

Thank you for submitting your POC. There is one correction requested in item #3 . Please change item 3 to state, directly to CCL.

(Fingerprints information should NEVER be sent to the LPA. Proof (always include your license/facility number on documents) should be sent to CCL office and it will be distributed to the appropriate person. Please note that the assigned LPA can change, as I am not the assigned LPA, but the visit had to be completed .)

Thank you .

Barbara Walker Licensing Program Analyst SJRO/Community Care Licensing 2580 N. First Street, Ste 300 San Jose, CA 95131 408-324-2148 main 408-334-8553 cell 408-324-2160 fax

[email protected]

-----Original Message-----

1

""From : Tag: rt, Mary [ mailto:mtagart~llengerschool.com ] Sent: Monday, February 03, 2014 2:29 PM To: Walker, Barbara JB.@DSS Cc: Mounteer, Dave; Huang, Lois; Matani, Geeta; Taplin, Melanie Subject: Plan of Correction for Challenger School Almaden campus 434400459

Ms. Walker,

Please find attached our Plan of Correction in connection with your Facility Evaluation Report of our Almaden campus campus dated January 30, 2014.

Mary Tagart Executive Administrative Assistant Challenger School

2

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT CCLD Regional Office, 2560 N FIRST STREET, STE. 300 SAN JOSE, CA 95131

FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES

FACILITY NUMBER: FACILITY TYPE:

434400459 850

4083772300 95120

01 /30/2014 11:15 AM 02:15PM

ADDRESS: 19950 MCKEAN ROAD TELEPHONE: CITY: SAN JOSE STATE:CA

CENSUS: 44 UNANNOUNCED

ZIP CODE: CAPACITY: 119 DATE: TYPE OF VISIT: Required - 5 Year

Geeta Matani TIME BEGAN:

MET WITH: TIME COMPLETED:

NARRATIVE

LPA Barbara Walker conducted an unannounced random required 5 year visit to the facility today. LPA met with director Geeta Matani. Present director, quality assurance staff, 7 teachers and 44 preschool children . LPA toured the Facility both inside and outside during today's visit. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 61 0), Earthquake Preparedness Checklist (LIC 9148) , Parents' Rights Poster (PUB 393) , Personal Rights (LIC 613A) , Child Car Seat Law, Snack menu , and Activity Schedule.

A review of staff records on 1/29/2014 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 LPA observed the Identification & Emergency Information form (LIC 700) in 10 children 's files. LPA 18 observed the required health screening in 14 staff files. There is at least one staff with current 19 CPR/1st Aid on site at all times , which expires 12/2014. Director understands that a staff must have 20 valid CPR and First Aid certifications , on site at all times or present during off-site activities (field 21 trips). LPA observed that the teacher/child ratio was in compliance during today's visit. Director 22 understands the conditions , limitations, and capacity specifications of the Facility license. Director 23 understands that children shall be visually supervised at all times. Facility sign in/out is in ~~ compliance. Facility Roster is in compliance.

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152

LICENSING EVALUATOR NAME: Barbara Walker TELEPHONE: 408-334-8553

DATE: 01 /30/2014

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01 /30/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC609 (FAS) - (06/04) Page: 1 ol3

J

STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 2580 N FIRST STREET, STE. 300 SAN JOSE, CA 95131

FACILITY NAME: CHALLENGER SCHOOL FACILITY NUMBER: 434400459

VISIT DATE: 01 /30/2014

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

NARRATIVE

LPA observed that the rooms are clean and safe for all children and staff. Drinking water is readily available for the children in room and in the outdoor playgrounds area via fountain . Staff bathrooms are clean , sanitized , and operable. Director states that there are no weapons on the premises.

Children bring their own lunch . Cleaning supplies are inaccessible to the ch ildren. Any medications at the faci lity are stored appropriately in the office.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the ch ildren. LPA observed that the outdoor equipment is age appropriate and in good condition . There is also sufficient resilient materials (type: tanbark and rubber) in the outdoor playground area. LPA did not observe any bodies of water.

LPA discussed the requirements of AB 633 with the director and previously provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and she understands the requirements. LPA also discussed "zero tolerance" related regulations with the director and advised her of the assessment of an immediate $150 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $150 per day continues until the violation(s) is corrected.

TYPE A DEFICIENCY SITED.

NOTICE OF SITE VISIT ISSUED POSTED, AND REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152

TELEPHONE: 408-334-8553 LICENSING EVALUATOR NAME: Barbara Walker

LICENSING EVALUATOR SIGNATURE:

DATE: 01 /30/2014

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


DATE: 01 /30/201 4

LIC809 (FAS) • (06/04) Page: 3 of 3

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CHALLENGER SCHOOL

DEFICIENCY INFORMATION FOR THIS PAGE:

Deficiency Type POC Due Date I DEFICIENCIES Section Number

Criminal Record Clearance.

1 Two cleared staff, Mallory Powers & Blanca

Type A 2 Rodriguez fingerprints were not transferred to

02/03/2014 3 facility. 4

Section Cited 5 Prior to working or volunteering in a licensed child 1 01170(e)(2) 6 care facility, all individuals subject to a criminal

7 record review shall request a transfer of a criminal record clearance from another facility or Trustline.

8 9 10 11 12 13 14

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

8 9 10 11 12 13 14

1 2 3 4 5 6 7

1 2 3 4 5 6 7


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

FACILITY NUMBER: 434400459 VISIT DATE: 01/30/2014

PLAN OF CORRECTIONS(POCs)

Director to send transfer requests to CCL (Completed at time of visit.). and submit a written plan on how center will ensure that prints are transferred and cleared prior to employment.

AB 633 states upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months and it is to be signed and kept in each child 's file.

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: Mary Segura TELEPHONE: {408) 324-2152

LICENSING EVALUATOR NAME: Barbara Walker


TELEPHONE: 408-334-8553

DATE: 01 /30/2014



DATE: 01 /30/2014

This Notice must be posted for 30 days

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGEN CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FACILITY VISIT CHECKLIST CHILD CARE CENTERS AND INFANT CENTERS

Review facility file prior to visit. Check to see that the following information has been updated, if required, and contained in the file. Indicate the date the information was submitted to the licensing agency in the space provided for each item requested.

LICENSE ANNIVERSARY DATE DATE DATE

ON FILE REQUESTED RECEIVED

Application Information (LIC 215) / Criminal Record Clearance and Child Abuse Index Checks (LIC 198) (updated for current staff subject to fingerprint requirements) ./ Licensee Affidavit Regarding Persons Exempt From Fingerprint Requirements (if not on LIC 500) . / Administrative Organization (LIC 309)* / Estimated Monthly Operating Budget (LIC 401 ), Budget Information (LIC 420), Financial

/ Statement and Information (LIC 403, LIC 404)

Articles of Incorporation, Constitution and Bylaws (if applicable) /'

Partnership Agreement (if applicable) / Designation of Administrative Responsibility (LIC 308)* ~

Personnel Report (LIC 500) Updated* / Facility Floor/Plot Plan (LIC Q99) /

Verification of Qualifications of Facility Director / Emergency Disaster Plan (LIC 610) / Disaster and Fire Drills (every 6 months) / Plan of Operation /

Admissions Policies and Procedures/Fee Schedule / /

Health Screening Report- Facility Personnel (LIC 503)

Daily Activity Schedule /

Fire Clearance (consistent with terms and limitations of license) /

Bacteriological Analysis of Private Water Supply (if applicable) -License Fee Received /

NOTES AND COMMENTS

Postings (License, Emergency Plan, Earthquake, Parents' Rights Poster, Personal Rights, Car Seat Law, Menus, Activity List)?

Naivers?

solation of Sick Children? Enough Food (expiration)? fJ(/11 d vledication? Mats/Cots (good condition)? ~

:-irst Aid Kit? Outdoor clean? V Sufficient Resilient Material (in playground)?

Bodies of Water? YkJ lathrooms (clean/working)?

:hanging Table (infants)? ·

lrinking Water? V ood Prep/Plan/Dishes? /J/ fr : 9118 (11/03)

*Other verifying documents may be substituted for these LIC forms

CHALLENGEK S C H 0 0 L

August 31, 2009

Roya Shahkarami Licensing Program Analyst Department of Social Services Community Care Licensing 2580 North First Street, Suite 300 San Jose, California 95131

Re: Playground modification - 19950 McKean Road, San Jose, CA 95120 (434400459)

Dear Roya,

The preschool playground modification at our Almaden campus was completed as of August 29, 2009.

The footprint of the playground remains the same with an area of 17,108 sq. ft. Attached please find a site plan of the remodeled area and photographs of the new equipment.

Should there be any questions, please contact Mary Tagart at Challenger School ' s Region Office (408) 37 2300.

Dave Mounteer Executive Region Director Challenger School

Enclosure

DM/mkt

900 East Hamilton Avenue, Suite 330, Campbell , CA 95008 (408) 377-2300 FAX (408) 377-2498


COMPLAINT INVESTIGATION REPORT


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

This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 07/14/2010 and conducted by Evaluator Roya Shahkarami

PUBLIC COMPLAINT CONTROL NUMBER: 07-CC-20100714142131

FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES ADDRESS: 19950 MCKEAN ROAD CITY: SAN JOSE CAPACITY: 119

MET WITH: Judy Burbank

ALLEGATION(S): 1 Unqualified staff used in ratio . 2 3 4 5 6 7 8 9

INVESTIGATION FINDINGS:

STATE: CENSUS: 37 UNANNOUNCED

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED:

434400459 850

(408) 377-2300 95120

07/26/2010 09 :10AM 11:50 AM

1 A visit was made to the facility . Toured 4 class rooms and interviewed staff. After reviewing staff, sub and 2 break giver's records, analyst learned that staff that are being utilized in the preschool are not qualified 3 teachers. 4 The finding to above allegation is substantiated. The fol lowing type B deficiency is cited. 5 Notice of site visit was posted and the notice must be up for 30 days. 6 7 8 9 10 11 12 13

Substantiated

SUPERVISOR'S NAME: Sandy Knight

LICENSING EVALUATOR NAME: Roya Shahkarami


Estimated Days of Completion:

TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 07/26/2010



DATE: 07/26/2010

This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 2

Control Number 07-CC-20100714142131 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

FACILITY NAME: CHALLENGER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE:


1 Teacher- Child Ratio; Type B 2 During today's visit analyst observed and learned

07/30/2010 3 that they are using staff for teacher's break that are 4 not fully qualified as a preschool's teacher. Section Cited 5 Violation of Title 22.

101216.3 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7



FACILITY NUMBER: 434400459

VISIT DATE: 07/26/2010


They will correct this deficiency by rearranging staff in their class rooms. A written plan of correction will be mailed to analyst by 08/10/10. They correct this deficiency for today, however they need to rearrange staffs schedules to meet the ratio for the rest of summer period and their fall school year.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.




TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 07/26/2010



9\/l~)YL~ DATE: 07/26/2010

LIC9099 (FAS) • (06/04) Page: 2 of 2


FACILITY EVALUATION REPORT

FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES ADDRESS: 19950 MCKEAN ROAD CITY: SAN JOSE CAPACITY: 119 TYPE OF VISIT: POC MET WITH: Judy Burbank


SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300 SAN JOSE, CA 95113

STATE:CA CENSUS: 100 UNANNOUNCED

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED:

434400459 850

(408) 377-2300 95120

02/04/2009 01 :50PM 02:50PM

NARRATIVE

1 A follow up visit was made to the facility to verify correction to deficiencies cited on 01 /21/09. Violet Seryani 2 was out of the facility due to family emergency. Toured facility and observed all deficiencies have been 3 corrected . They have removed the boat from their playground. They have fixed their water fountains . They 4 have added one extra staff to the class room 4 during nap time for the children who do not want to sleep. 5 All deficiencies cited have been cleared . 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 02/04/2009



DATE: 02/04/2009


LIC809 (FAS) - (06/04) Page: 1 of 1



FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES ADDRESS: 19950 MCKEAN ROAD CITY: SAN JOSE CAPACITY: 119 TYPE OF VISIT: POC MET WITH: Geeta Matani

I



STATE:CA CENSUS: 49 UNANNOUNCED


434400459 850

(408) 377-2300 95120

08/26/2010 10:40 AM 11 :40 AM

NARRATIVE 1 A follow up visit was made to the facility to verify correction to deficiency cited on 07/26/10. Met with newly 2 hire Director, Geeta Matani. Reviewed her records and she is a fully qualified teacher. She stated that she has 3 hired two staff that they only give breaks to teachers. Reviewed both staffs records and they are a fully 4 qualified teacher. 5 Geeta stated that they only hire teacher with minimum of 12 semester units in ECE. 6 Toured facility and observed children in play ground and one class room. During today's visit, the ratio was 7 correct and children were under visual supervision . 8 Deficiency cited on 07/26/10 has been corrected. No new deficiency noted. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 08/26/2010



DATE: 08/26/2010


LIC809 (FAS) • (06/04) Page: 1 of 1

~ 1 A 1 t: u r L.Jo4.U t" UHNIA- t1C.AL I t1 AN U HUMA N ::,t:HVICE!:i AC,;it:NCY CAUFORNIA DEPARTM!:NT OF SOCIAL SERVICES

ANNUAL LICENSE VISIT CHECKL f CHILD CARE CENTERS AND INFANT CENTERS

Review facility file prior to annual license visit. Check to see that the following information has been updated, if required, and contained in the file. Indicate the date the information was submitted to the licensing agency in the space provided for each item requested.

LICENSE ANNIVERSARY DATE

Criminal Record Clearance and Child Abuse Index Checks (LI C 198) (updated tor current staff subject to fingerprint requirements)

Licensee Affidavit Regarding Persons Exempt From Fingerprint Requirements (it not on LIC 500)

Administrative Organization (LIC 309)"

Estimated Monthly Operating Budget (LIC 401 ), Budget Information (LIC 420), Financial Statement and lnfonnation (LIC 403. LIC 404)

Articles of Incorporation, Constitution and Bylaws (if applicable)

Partnership Agreement (it applicable)

Designation of Administrative Responsibility (LIC 308)'

Personnel Report (LIC 500) Updated·

Facility Floor/Plot Plan (LIC 999) ·- v I Verification of Qualifications of Facility Director

Emergency Disaster Plan (LIC 61 0)

Disaster and Fire Drills (every 6 months)

Plan of Operation

Admissions Policies and Procedures/Fee Schedule I Health Screening Report - Facility Personnel (LIC 503)

Daily Activity Schedule

Fire Clearance (consistent with terms and limitations of license)

Bacteriological Analysis of Private Water Supply (if applicable)

License Fee Received

NOTES AND COMMENTS

ON FILE

J /

/ , I

/

/ /

" ~ I I ,. ,

-

uc 9118 (3199) ·other veritying documents may be substituted for these LIC forms

DATE I DATE REQUESTED RECEIVED

I I

I I

I I I

l I I I I

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT SAN JOSE·DAY CARE, 2580 N FIRST STREET, STE. 300 SAN JOSE, CA 95113

FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES

FACILITY NUMBER: FACILITY TYPE:

434400459 850

(408) 377-2300 95120

01 /21 /2009 01:35PM 06:40PM

ADDRESS: 19950 MCKEAN ROAD TELEPHONE: CITY: SAN JOSE STATE:CA

CENSUS: 89 UNANNOUNCED

ZIP CODE: CAPACITY: 119 DATE: TYPE OF VISIT: Annual/Random TIME BEGAN: MET WITH: Violet Seryant TIME COMPLETED:

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

NARRATIVE An unannounced Annual/Random visit was made to the facility. Met with Director, Violet Seryant. Toured inside and outside of the facility. Toured class rooms 1,2,3,4,and 5. Observed children during nap time, circle time and snack time. Class room 2,3,4 are full time preschooler from 7 AM-6 PM. Class room 1 and 5 each has two sessions. One session is from 8:45-11:45 AM and second session is from 12:45 PM-3:45PM. Children nap in class rooms 2,3, and 4. Each child has an individualized mat and bedding. They wash and sanitize mats and bedding once a week. There is water fountain in each class room . Toured Play ground which has pebbles for their resilient material. There is a water fountain in the playground which the pressure of it was low, not adequate for children. building overhangs provide adequate shaded areas for children . Discussed ratio , supervision , regulations regarding fingerprint clearances, and required forms that should be posted. Parents provide children's lunches and facility provides morning and afternoon snacks. Reviewed sign in/ sign out sheet. They have running hot and cold water in the kitchen . All garbage cans have tight fitting lids. LPA observed a fire extinguisher and a fully equipped first aid kit in each class room. The facility does administer medication . Discussed regulation and their policy regarding medication. Medications are stored in director's office. Director is the only person who administer medication if needed. Their last emergency drill was on 1/13/09. Reviewed sampling of children's and all staffs records. Issued several passports . Forms and Title 22 Regulations can be obtained through the internet at www.cdss.ca.gov. There is no active waiver for this facility. The following forms should be mailed to Licensing by 02/20/09: ** Updated Lie 309. ** Updated Lie 308. ** Updated Lie 500. ** Updated admission agreement that includes the Licensing Rights. A review of the staff records on 1/21/09 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. NOTICE OF SITE VISIT WAS POSTED. THE NOTICE MUST BE UP FOR 30 DAYS. The following type B deficiency are cited: See next page:

SUPERVISOR'S NAME: Sandy Knight TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312 LICENSING EVALUATOR NAME: Roya Shahkarami


DATE: 01/21/2009



1)~~ DATE: 01 /21 /2009


LIC809 (FAS) • (06/04) Page: 1 of 3






1 FIXTURES, FURNITURE, EQUIPMENT AND

Type B 2 SUPPLIES

02/20/2009 3 The boat on the playground observed to be 4 damaged. The fiberglass coating on the rear

Section Cited 5 interior of the boat is peeling and exposing wood 101239(0)(1) 6 that is weathered and splintering. Paints are

7 chipping off. Violation of Title 22.

1 Child 's Records- Children's records were missing Type B 2 Lie 627. Violation of Title 22.

3 02/20/2009 4

Section Cited 5 101221 6

7

1 Activities/ Napping- during today's visit obseved 23

2 children in Room 4 with one teacher. Half of the Type B

3 children were up and very restless and teacher 01/25/2009 4 kept telling them to stay down. Teacher stated that

Section Cited 5 they have 2 hrs of nap time in that class room. She 101230 (b)(3) 6 agreed with analyst that 2 hrs nap is a long time

7 for that age group. Violation ofTitle 22.

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This deficiency was cited during 2002 visit. Analyst recommended to remove the boat or repair the boat. They need to maintain the boat in a safe and good condition at all time.

Analyst printed a copy of Lie 627 for director. she needs .to add it to children's records.

No child should be forced to stay awake or to stay in the napping area longer than what they need. The facility need to add another teacher in that class room for children who are finished with their nap. Those children could be doing quite activity time with added second teacher in class room during their nap schedule.





TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 01/21/2009



v~~ DATE: 01/21/2009

LIC809 (FAS) • (06/04) Page: 2 of 3






Drinking water- The water pressure was not adequate in the outside water fountain and in the

1 class room. Analyst observed a child in room 4 had

Type A 2 to be on her toes to reach for water fountain . Due

01 /23/2009 3 to her height and water pressure of the fountain ,

Section Cited 4 she had to put her whole mouth on the fixture. Staff 5 did not notice it and therefore the fixture was not

101239.2(a) 6 sanitized. Violation of Title 22. 7 THIS REPORT MUST BE GIVEN TO EACH

CURRENTANDFUTUREPARENTSANDTHEY NEED TO SIGN LIC 9224.

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Children should have access to non contaminating drinking fixture.





TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8312

DATE: 01/21/2009



q/~~ DATE: 01/21/2009

This Notice must be posted for 30 days

STATE OF CALIFORNIA· HEALTH AND H SERVICES AGENCY


FACILITY NAME: CHALLENGER SCHOOL ADMINISTRATOR: NANCY NACIONALES ADDRESS: 19950 MCKEAN ROAD CITY: SAN JOSE STATE: CA CAPACITY: 96 CENSUS: 15 TYPE OF VISIT: Prelicensing UNANNOUNCED MET WITH: Violet Seryani/Mary TagarULois Huang

NARRATIVE

\ ?_RNIA DEPARTMENT OF SOCIAL SERVICES o-.-t~NITY CARE LICENSING DIVISION

San Jose Child Care, 2580 N First Street, #300 San Jose, CA 95131


434400459 850

(408) 377-2300 95120

08/07/2008 08:30AM 11 :30 AM

1 LPA Meela Aguas met with Site Director Violet Seryani , Business Manager, Mary Tagart and Director of 2 School Operation , Lois Huang for a prelicensing visit due to a request for increase of capacity from 96 3 children to 119 children. LPA toured the facility indoors and out. The additional room will be Room 5. 4 Rooms 1, 2, 3 & 4 are currently licensed for 96 children and have sufficient cubbies and mats. Room 5 has 5 sufficient cubbies, chairs, tables and no napping mats since the room will be used for 2 half sessions 6 (AM/PM). 7 Indoor measurements are as follows: 8 Room 1 30.581 x 27.83- (8.498 x 11 .166) = 756.181 9 Room 2 31 .332 x 28.083 = 879.896 10 Room3 31.249x28.332-(16.166x2)=853.014 11 Room 4 861.42 sq . ft . Refer to facility report dated 01/18/07 12 Room 5 29.498 x 29 - (8.913 x 3.249) = 826.484 13 TOTAL INDOOR SPACE ROOM 1,2, 3, 4 & 5 = 4,176.995 sq. ft. divided by 35 = 119 children. 14 15 There are 8 toilets (120) and 9 sinks (135) available to children. Only cold water is available in the sinks. Staff 16 have a separate bathroom which is located by the office. The sink/toilet for sick children is in the office. Sick 17 children will be isolated in the quiet area in the office and isolation equipment is provided. 18 19 Outdoor measurements are as follows (Refer to facility report dated 8/19/04 & 8/28/98): 20 Outdoor Space 1 04 x 139 = 14456 21 52 X 51 = 2652 22 TOTAL OUTDOOR SPACE = 17,108 sq. ft. divided by 75 = 228 children 23 24 Pending completion of the following, LPA will grant increase in capacity to 119 children: 25 Fire Clearance

NOTICE OF SITE VISIT WAS ISSUED AND POSTED.

SUPERVISOR'S NAME: Michele Wong

LICENSING EVALUATOR NAME: Milagros Aguas


TELEPHONE: (408) 324-2148

TELEPHONE: (408) 334-8550

DATE: 08/07/2008



q/~ DATE: 08/07/2008


LIC809 (FAS) • (06/04) Page: 1 of 1

CHALLENGER s c H o o L loo8 Ju,

'-It,

July I 0, 2008

Mary Smith Department of Socia l Services Community Care Licensing 2580 N. First Street, #300 San Jose, California 95131

P}f ~: Og

Re : Capacity change - A lam den campus, 19950 McKean Road, San Jose ( 434400459)

Mary,

We are submitting an application for a capacity increase at our Almaden campus from 96 to 120. We wou ld like to license room 5 wh ich is adjacent to licensed room 4. Room 5 is currently used for kindergarten students and will be able to accommodate the allotted maximum of 24 preschool students during standard operating hours.

* Current ly the facility has 8 toilets and 8 sinks licensed which allows for an acceptable ratio of children to toilets/sinks of 15: I. In addit ion , Room 5 has one sink.

* The facility outdoor activ ity space, with playground, has a total of 17, I 08 square feet.

* Emergency evacuation procedures will be conducted in accordance with estab li shed school direction.

Please contact me at (408) 377-2300 once you have had an opportunity to review this application so that we can coordinate a ll necessary follow-up. We wish to schedule inspection of this site on August 7th or 8th

2008.

Sincerely,

~Ja~ Mary Tagart Region Business Manager

900 East Hamilton Avenue, Suite 330, Campbell, Cal iforn ia 95008 (408) 377-2300 FAX (408) 377-2498



FACILITY NAME: DIRECTOR: ADDRESS: CITY:

CHALLENGER SCHOOL

ADAMS, SHERRY 19950 MCKEAN ROAD SAN JOSE

CAPACITY: 69 TYPE OF VISIT: Prelicensing MET WITH: Nancy Nacionales


CALIFORNIA DEPARTMENT OF SOCIAL SERVICES G:OMMUNITY CARE LICENSING DIVISION

San Jose Child Care, 111 N. Market st #300

STATE:CA

San Jose, CA 95113

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE:

CENSUS: 0 DATE: UNANNOUNCED TIME BEGAN:

TIME COMPLETED:

CIVIL PENALTY INFORMATION:

434400459

850 (408) 377-2300

95120

08/19/2004 08:30AM 09:30AM

COMMENTS/DEFICIENCIES

1 LPA Angela Carmack met with Director Nancy Nacionales and Director of Business Operations Lois Huang 2 for a pre licensing visit to add a classroom and increase capacity to 96 from 72. Fire Marshall was out on 3 8/18/04 to give classroom a fire clearance. 4 5 Room 4 29.3 x 29.4 = 861.42 6 ROOMS INDOOR SPACE: 861.42 sq. ft. divided by 35 = 24 children 7 Measurements for the yard were measured by Saundra Norvell 8/98. The yard has remained the same 8 with no alterations. 9 OUTDOOR SPACE 104 x 139 = 14456 1 0 52 X 51 = 2652 11 OUTDOOR SPACE: 17, 108 sq. ft. divided by 75 = 228 children 12 13 14 There are 2 sinks (30) and 2 toilets (30) for children's use in Room 4. There are adequate tables, chairs and 15 cubbies. Program has adequate toys and activities for children. Drinking water outside is provided by water 16 fountain on the playground and the classroom has a water fountain available. 17 18 19 LPA WILL ORDER A LICENSE FOR AN INCREASE OF CAPACITY TO 96, SCHOOL IS DUE TO OPEN 20 8/30/04. 21 22 23


SUPERVISOR'S NAME: Norvell Saundra

LICENSING EVALUATOR NAME: Angela

LICENSING EVALUATOR SIGNATURE:_..:...;...~~~~:.=..uo:;'-UOCl:.........:.---

LIC809 (FAS) - (4196)

TELEPHONE: (408)277-1286

TELEPHONE: (408)277-1467

DATE: 08/1912004

DATE: 08/1912004

Page: 1 of1

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