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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415601
Report Date: 06/17/2021
Date Signed: 06/17/2021 10:43:37 AM

Document Has Been Signed on 06/17/2021 10:43 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: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: 17DATE:
06/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Danna Matthew OsbornTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Mel Matos and Ofelia Calivo conducted an unannounced case management inspection. LPAs met with Danna Matthew Osborn, director, and explained the nature of today's inspection to her. Purpose of today's inspection: conclude investigation regarding an Unusual Incident that the Facility self reported to the Department on March 11, 2021. LPAs previously discussed the incident with Danna on March 25, 2021 and determined that additional investigation re: the Unusual Incident was required.

LPAs interviewed Danna, two staff, parents, and one preschool child for this investigation. Based on observations, record reviews, and interviews completed for this investigation, it is concluded that there is not a preponderance of evidence to prove the alleged violation (teacher pinched a child in the Facility) did or did not occur.

A copy of the PIN 21-08-CCLD was provided to and discussed with Danna prior to the conclusion of today's inspection.

An exit interview was conducted with Danna and Danna was advised that no deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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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