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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270710326
Report Date: 11/14/2025
Date Signed: 11/14/2025 12:07:13 PM

Document Has Been Signed on 11/14/2025 12:07 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:APPLE PIE SCHOOLFACILITY NUMBER:
270710326
ADMINISTRATOR/
DIRECTOR:		MARGARET ROSE LOPEZFACILITY TYPE:
850
ADDRESS:CA 1 AT CAPTAIN COOPER SCHOOLTELEPHONE:
(831) 667-2921
CITY:BIG SURSTATE: CAZIP CODE:
93920
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 9DATE:
11/14/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Tafay WilsonTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On November 14, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted a 3 year required inspection at the facility. LPA Barnes met with Site Supervisor Margaret Lopez , explained the purpose of the visit, and was granted access. Lopez was provided with the LIC125 Entrance Checklist. Present during the inspection were Lopez, Lead Teacher Tafay Wilson, Para Educator Lauren Garcia, and nine preschoolers.

Apple Pie School was located on the campus of Captain Cooper Elementary School and operated Monday through Friday from 8:30 a.m. to 4:00 p.m. Parents provided meals and drinks, though meals and drinks are also provided through the school district. All food brought from home was labeled with the child’s name and placed in the refrigerator if needed and lunch boxes are left in their cubby. The facility followed scheduled mealtimes for breakfast snack, lunch, and an afternoon snack. School district meals are prepared at the school district and delivered daily to the facility. Filtered water from dispensers was available throughout the day.

All required postings had been publicly visible throughout the facility. The building had been equipped with a built-in fire and smoke alarm system and carbon monoxide detectors. No smoking was allowed on the campus. The most recent fire drill had taken place on November 5, 2025, and the Site Supervisor had been reminded to conduct and document fire drills at least once every six months. A 3A-40-BC fire extinguisher, last serviced on 7/10/25, had been located on site. An operating telephone had been present, and the Site Supervisor had confirmed that no firearms were stored or present on the premises.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/14/2025 12:07 PM - It Cannot Be Edited


Created By: Darnella Barnes On 11/14/2025 at 11:39 AM
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: APPLE PIE SCHOOL
FACILITY NUMBER: 270710326

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. One Staff is missing measles immunization
POC Due Date: 11/18/2025
Plan of Correction
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Site Supervisor Lopez will provide LPA a written documentation of the measles immunization for staff to LPA. Also Site Supervisor Lopez shall provide a written plan of action that will state how this type of incident will be prevented from happening again.
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. Childrens files are missing LIC627 Consent for Emergency Medical Treatment
POC Due Date: 11/21/2025
Plan of Correction
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Site Supervisor Lopez shall provide LPA written documentation of LIC627 Consent for Emergency Medical Treatment for all 9 children. Also Site Supervisor Lopez shall provide a written plan of action that will state how this type of incident will be prevented from happening again.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Darnella Barnes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2025


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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: APPLE PIE SCHOOL
FACILITY NUMBER: 270710326
VISIT DATE: 11/14/2025
NARRATIVE
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Fingerprint clearances for all individuals requiring caregiver background checks were obtained through the State Department and/or County Office of Education and are not under the jurisdiction of Community Care Licensing Division.

LPA Barnes conducted an inspection of the indoor environment. The area appeared clean, safe, and well-maintained. Flooring was in good condition and free of tripping or slipping hazards. Toy containers had smooth edges, proper ventilation, and finger-safe lids. Each child was assigned an individually labeled storage space.

LPA Barnes observed mats made of vinyl or a similar moisture-resistant material of at least an inch thickness. Site Supervisor stated that the mats were wiped and disinfected weekly and whenever soiled or wet. The mats appeared to be in safe condition with no exposed stuffing. Fitted sheets for the mats and children’s blankets were sent home, washed weekly and stored separately to prevent cross-contamination

Bathroom facilities met the required ratio of one sink and toilet per fifteen children. Toileting areas, including walls, floors, sinks, and dispensers, were regularly cleaned and disinfected. The sink used for rinsing soiled items was sanitized after each use. All areas inspected were organized, clean, and maintained.

Cleaning supplies and chemicals were stored in locked cabinets, separate from food and out of children’s reach. Floors were mopped and carpets vacuumed daily. Trash was disposed of in covered containers. The indoor temperature was recorded at 69 degrees Fahrenheit.

LPA Barnes reviewed five children’s files. All files were complete and included the Admission Agreement, Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Physician’s Report (LIC 701), immunization records, TB test results, Personal Rights (LIC 613A), Notification of Parent’s Rights (LIC 995A), and Pre-admission Health History. Each file also contained documentation of 15-minute sleep checks and the Infant Safe Sleep Plan. The children’s files were each missing LIC627 Consent for Emergency Medical Treatment a Citation B was issued on LIC 809D.

Facility roster and sign-in/out sheets were reviewed. All entries used full legal signatures with accurate times recorded.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: APPLE PIE SCHOOL
FACILITY NUMBER: 270710326
VISIT DATE: 11/14/2025
NARRATIVE
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LPA Barnes reviewed the staff files and confirmed that each contained up-to-date Pediatric First Aid and CPR certification, Mandated Reporter Training, job applications, health screenings, child abuse reporting acknowledgments, employee rights forms, and proof of educational qualifications. One teacher was missing Mandated Reporter Certification a Citation B was issued on LIC809D. Barnes reminded the Site Supervisor that Mandated Reporter Training needed renewal every two years and emphasized that at least one staff member must always hold current CPR and First Aid certification. Aides and assistants were required to remain under the direct supervision of a qualified teacher, except during naptime or bathroom transitions.

During the outdoor inspection, LPA Barnes observed that all walkways, ramps, and stairs were free of hazards. The play area provided adequate shade and was organized to minimize the risk of injury. The outdoor space was fenced at least five feet high, was free of debris, and did not contain any accessible hazards or bodies of water.

First aid supplies were observed in an accessible location for staff and out of children’s reach.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.



Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the Site Supervisor shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: APPLE PIE SCHOOL
FACILITY NUMBER: 270710326
VISIT DATE: 11/14/2025
NARRATIVE
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Site Supervisor was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California..

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



During today’s inspection, (2) “Type B” deficiencies are issued on attached 809-D. Appeal rights provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor Margaret Lopez.



----END OF THE REPORT ----
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC809 (FAS) - (06/04)
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