<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710174
Report Date: 08/02/2023
Date Signed: 08/02/2023 09:39:36 AM

Document Has Been Signed on 08/02/2023 09:39 AM - 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:DE ANZA COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430710174
ADMINISTRATOR:NAOKO NANCY HARADAFACILITY TYPE:
850
ADDRESS:21250 STEVENS CREEK BLVD.TELEPHONE:
(408) 864-5795
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 217TOTAL ENROLLED CHILDREN: 63CENSUS: 54DATE:
08/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tim HarperTIME COMPLETED:
09:50 AM
NARRATIVE
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
Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management Inspection. LPA met with Director, Tim Harper, and explained the purpose of today's visit. An initial Case Management inspection was conducted on June 14, 2023 regarding an alleged incident involving a staff member violating a child's personal rights. The facility was cited on June 14, 2023 for failure to report the alleged incident to Community Care Licensing.

Community Care Licensing Investigator, James Santos, coordinated the investigation with Foothill-De Anza Community College District Police Department. Based on police report and evidence gathered, there is no preponderance of evidence to prove that the staff violated a child's personal rights or there was lack of supervision.

As a result of this inspection, there were no deficiencies cited.

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: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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 1