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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700960
Report Date: 01/06/2025
Date Signed: 01/06/2025 03:41:07 PM

Document Has Been Signed on 01/06/2025 03:41 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ACTION DAY NURSERY ON MOORPARKFACILITY NUMBER:
430700960
ADMINISTRATOR/
DIRECTOR:		STRANGE, BRITTANYFACILITY TYPE:
850
ADDRESS:3030 MOORPARK AVENUETELEPHONE:
(408) 247-6972
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 233TOTAL ENROLLED CHILDREN: 143CENSUS: 116DATE:
01/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Brittany Strange & Cassia AzevedoTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and Shine Yu conducted a Case Management inspection. LPAs met with Site Director, Brittany Strange, and Preschool Administrator, Cassia Azevedo. LPAs learned from interviews that a child (C1) was left unsupervised outside of Room 8 in October 2024. C1 was standing by the door of Room 8 alone when found by a parent. The two staff involved were terminated. This incident was not reported to Licensing.

As a result, Type A & Type B deficiencies were cited on the following pages.

Assembly Bill (AB) 633 was provided and discussed with Preschool Administrator. LPAs informed the Preschool Administrator to provide a copy of this licensing report dated January 6, 2024 that documents a Type A citation to parents/guardians of all children currently enrolled no later than the next business day or the next day the children are in care, and to parents/guardians of any newly enrolled children for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224) must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Preschool Administrator, Cassia Azevedo.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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Document Has Been Signed on 01/06/2025 03:41 PM - It Cannot Be Edited


Created By: Marilou Monico On 01/06/2025 at 03:00 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: ACTION DAY NURSERY ON MOORPARK
FACILITY NUMBER: 430700960

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The two staff who failed to provide supervision to the child were terminated.

Deficiency corrected.
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This requirement was not met as evidenced by: In October 2024, a child (C1) was left unsupervised outside of Room 8. This posed an immediate risk to the health, safety, and personal rights to persons 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:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/06/2025 03:41 PM - It Cannot Be Edited


Created By: Marilou Monico On 01/06/2025 at 03:10 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: ACTION DAY NURSERY ON MOORPARK
FACILITY NUMBER: 430700960

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
101212(d)(1)(C)

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Reporting Requirements - Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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By POC due date: 01/10/25, Licensee to submit a written plan to ensure that unusual incident shall be reported to Licensing within the required time frame.
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This requirement was not met as evidenced by: An incident that happened in October 2024 involving a child who was left unsupervised outside Room 8 was not reported to Licensing. This posed a potential risk to the health, safety, and personal rights to 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:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2025


LIC809 (FAS) - (06/04)
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