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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416728
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:20:10 PM

Document Has Been Signed on 07/26/2023 03:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KASSEL, ALEXANDRIAFACILITY NUMBER:
434416728
ADMINISTRATOR:ALEXANDRIA KASSELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 427-2819
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alexandria KasselTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ashley Lopez and Cortney Nelson met with licensee Alexandria Kassel and explained the purpose of the visit. Upon arrival LPAs were granted access to the home by assistant, Nichelle, and toured inside and outside of home.

During tour of inside the home LPAs observed the day care home was over capacity with 7 children (1 infant and 6 preschool age) alone with assistant. Licensee arrived with 2 of her own children 15 minutes later. LPAs advised licensee that when assistant is alone she will need to follow the capacity requirements for a small child care home.

LPAs reviewed the Children's Roster and licensee's First Aid/CPR certification which expires 7/26/23 and the assistant's First Aid/CPR certification has expired on 6/8/23. LPAs advised that when left alone with children, the adult present needs to have current First Aid/CPR.

LPA's informed Alexandria that this report dated, 7/26/2023 documents a Type A citation which shall be posted for 30 consecutive days as there are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA's informed the licensee to provide a copy of this licensing report dated 7/26/2023 that documents Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KASSEL, ALEXANDRIA
FACILITY NUMBER: 434416728
VISIT DATE: 07/26/2023
NARRATIVE
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As a result of today's visit deficiencies were cited, see LIC809-D.

Exit interview conducted and report was reviewed with the licensee, Alexandria Kassel.

A notice of site visit was given and must be posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/26/2023 03:20 PM - It Cannot Be Edited


Created By: Ashley Lopez On 07/26/2023 at 02:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KASSEL, ALEXANDRIA
FACILITY NUMBER: 434416728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/27/2023
Section Cited
CCR
102416.5(e)

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102416.5 Staffing Ratio and Capacity (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement was not met as evidenced by:
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Licensee will submit a written attestation to licensing stating how she will stay in compliance with capacity and ratio. Licensee will submit by due date 7/27/23.
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The licensee did not follow small family child care home requirements while away from the home (7 children were present with 1 assistant), which poses an immediate risk to the health, safety, and personal rights of the children in care.
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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:Joel Segura
LICENSING EVALUATOR NAME:Ashley Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/26/2023 03:20 PM - It Cannot Be Edited


Created By: Ashley Lopez On 07/26/2023 at 02:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KASSEL, ALEXANDRIA
FACILITY NUMBER: 434416728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2023
Section Cited
HSC
1596.88(b)

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1596.88(b) ...licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR...shall be onsite at all times when children are present at the facility...

This requirement was not met as evidenced by:
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Licensee will submit current First Aid/CPR certification
or proof of enrollment to licensing by due date 8/9/23.

-LPAs will provide licensee with approved First Aid/CPR courses.
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The assistant present at the home without the licensee has a First Aid/CPR certificate that had expired on 6/8/2023, which poses a potential risk to the health, safety, and personal rights of children in care.
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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:Joel Segura
LICENSING EVALUATOR NAME:Ashley Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023


LIC809 (FAS) - (06/04)
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