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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415767
Report Date: 10/19/2021
Date Signed: 10/19/2021 04:48:43 PM

Document Has Been Signed on 10/19/2021 04:48 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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
434415767
ADMINISTRATOR:SHAYLYNN LUCASFACILITY TYPE:
850
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 96TOTAL ENROLLED CHILDREN: 56CENSUS: 29DATE:
10/19/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Annabelle CalasanzTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Legal/Non-compliance inspection. LPA met with Director Annabelle Calasanz and explained the reason for the inspection. The purpose of this inspection is to ensure that facility is adhering to plan of correction implemented during the Non-Compliance Conference held on 04/29/2021 in regards to providing care and supervision and health-related services. There were 29 children and 8 staff.

During today's inspection, LPA interviewed 3 staff. Director stated that they conducted an in-service day with all the staff on 10/11/2021 where she discussed about supervision. She also stated that they have hired more staff, who she can place in the classrooms for additional support. She also stated that they are working with a behavior support that helps provide them with resources when they have a child on a behavior plan. Staff also stated that they have My Path, which is a resource staff can use for behavior issues.

LPA also toured the inside and outside of the facility. At 3:55PM, LPA observed that there were 3 staff and 9 children in the preschool yard. LPA observed that one of the staff was walking with the children around the yard. There was one staff sitting facing the play structure with children and another staff that was standing by the picnic table, which was behind the staff that was sitting. Staff by the picnic table was facing the play structure. LPA observed that there was a child on the slide on the other end of the play structure. LPA observed that children cannot be visually supervised from where the staff were positioned. Director had staff stand on the other side of the playground where children can be visually supervised at all times. LPA discussed with Director that children need to be visually supervised at all times.

LPA also observed that there is a hole in the dirt area, which could become a tripping hazard. Director stated that she does have a work order in place.

As a result of this inspection, a Type B citation was cited. An exit interview was conducted where this report, citation, plan of correction, and appeal rights were discussed and provided to Director Annabelle Calasanz. A Notice of Site Visit was given and must be posted for 30 days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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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Document Has Been Signed on 10/19/2021 04:48 PM - It Cannot Be Edited


Created By: Samantha Yip On 10/19/2021 at 04:15 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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
This requirement is not met as evident by:
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By POC 10/29/2021, Director stated that she will send a memo to the staff about ensuring that children are visually supervised at all times and will send proof to Licensing with the list of staff who was provided the memo.
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Based on observation, LPA observed that there was a child on the slide and there was no staff positioned where they can visually supervise the child. This poses a potential risk to the health and safety to the children in care.
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During today's inspection, Director had staff position themselves where they can visually supervise the children on the slide.

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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:Anthony Studebaker
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2021


LIC809 (FAS) - (06/04)
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