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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415603
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:00:31 PM

Document Has Been Signed on 03/06/2025 01:00 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PEPPERTREE SCHOOLS COTTAGE HOUSEFACILITY NUMBER:
434415603
ADMINISTRATOR/
DIRECTOR:		JO-ANN PANGANFACILITY TYPE:
850
ADDRESS:16035 LOS GATOS ALMADEN ROADTELEPHONE:
(408) 356-3211
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 23DATE:
03/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Jo-Ann PanganTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Case Management - Deficiencies visit. Upon arrival, LPA was greeted by the Director Jo-Ann Pangan and provided access to the facility. Co-Director Danna Osborn arrived at approximately 12:35 PM. LPA stated the reason for the inspection was to review the plan of correction to repair the outdoor play area that was addressed in the Annual Inspection report dated 02/05/2025. LPA observed 23 children in care with 2 Teachers and 2 Directors which is compliant with ratio requirements and capacity limits.

Director Pangan stated the hole had not been repaired and requested an extension to make the correction. Co-Director Osborn stated a train play structure could be placed over the hole after the moisture had dried in the sun. This would make the hole inaccessible to children in care and would not hinder the manufacturer's recommendation of use for the play structure. LPA granted the extension and created a new plan of correction in the attached LIC809-D. LPA also stated a civil penalty of $100 would be assess to the facility for failure to correct the deficiency within the timeline agreed upon. Director did not ask LPA for an extension prior to the expiration date. Director was encouraged to communicate with LPA prior to expiration dates if deadlines cannot be met so that the Department can grant an extension if it is warranted.

Due to today's inspection, 1 Type B deficiency was cited and a civil penalty was assessed. Exit interview conducted with Co-Director Danna Osborn, report reviewed and provided along with appeals rights. NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 03/06/2025 01:00 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 03/06/2025 at 12:34 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: PEPPERTREE SCHOOLS COTTAGE HOUSE
FACILITY NUMBER: 434415603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2025
Section Cited
CCR
101238.2(d)(2)

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Outdoor Activity Space....(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
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Train play structure will be placed over the hole until maintenance can repair it long term. Facility will complete this by Monday 03/10/2025 and provide LPA with photographic proof.
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This requirement is not met as evidenced by:

Hole in playground has not been repaired. This poses a potential health and safety risk 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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