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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415601
Report Date: 03/25/2021
Date Signed: 03/25/2021 02:50:42 PM

Document Has Been Signed on 03/25/2021 02:50 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:PEPPERTREE SCHOOLS RANCH HOUSEFACILITY NUMBER:
434415601
ADMINISTRATOR:DANNA D MATTHEW OSBORNFACILITY TYPE:
850
ADDRESS:14969 LOS GATOS ALMADEN ROADTELEPHONE:
(408) 626-9200
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
03/25/2021
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Danna Matthew-OsbornTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Mel Matos and Ofelia Calivo conducted an announced case management tele-inspection (via FaceTime) today in response to an Unusual Incident that the Facility self-reported to the Department. LPA’s spoke with Danna Matthew-Osborn, director, and discussed the Unusual Incident with her.

LPAs also interviewed two staff during today’s tele-inspection. Further investigation is required, and a follow up case management tele-inspection will be conducted at a future date.

No deficiencies cited during today’s tele-inspection.

LPAs to forward a copy of today’s report to Danna Matthew-Osborn, via email (danna.osborn@peppertreeschools.com). LPAs requested that Danna respond to the “read receipt” confirmation/send confirmation of receipt email to LPAs within 24 hours confirming receipt of today’s report.

A Notice of Site Visit will also be forwarded to Danna via email and will be required to be posted near the entrance to the day care for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2021
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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