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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710174
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:47:28 PM

Document Has Been Signed on 06/18/2024 12:47 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:DE ANZA COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430710174
ADMINISTRATOR/
DIRECTOR:		TIM HARPERFACILITY TYPE:
850
ADDRESS:21250 STEVENS CREEK BLVD.TELEPHONE:
(408) 864-5795
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 217TOTAL ENROLLED CHILDREN: 93CENSUS: 72DATE:
06/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:13 AM
MET WITH:Tim HarperTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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 met with Site Director, Tim Harper, for an unannounced Case Management Inspection in response to an incident that was self reported by Site Director to Licensing on June 14, 2024 involving a daycare child (C-1).

During today's inspection, LPA toured the facility and interviewed staff. Based on the information gathered from interviews, it was determined that on June 13, 2024, a staff member (S-1) found C-1 in the bathroom located in Room 26 under the supervision of a practicum student (P-1). C-1 is a child enrolled in Room 14. Room 14 staff, children, and a therapist were in the playground adjacent to Room 26 bathroom at the time of the incident. Site Director indicated that per center's policy, practicum students are not part of the ratio and they cannot be left alone with the children.

As a result of this inspection, deficiency was cited on the following page:

Exit interview conducted and report was reviewed with Site Director, Tim Harper.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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 2
Document Has Been Signed on 06/18/2024 12:47 PM - It Cannot Be Edited


Created By: Marilou Monico On 06/18/2024 at 11:54 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: DE ANZA COLLEGE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430710174

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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.
1
2
3
4
5
6
7
By POC due date: 06/20/24, Site Director states that he will submit a written plan to ensure that only teachers or teacher assistants can supervise and take children to the bathroom.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: A staff member (S-1) found a daycare child (C-1) in the bathroom under the supervision of a practicum student. This poses a potential risk to the health, safety, and personal rights to persons in care.
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
1
2
3
4
5
6
7
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: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2