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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415769
Report Date: 04/21/2023
Date Signed: 04/24/2023 08:05:41 AM

Document Has Been Signed on 04/24/2023 08:05 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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
434415769
ADMINISTRATOR:ANNABELLE CALASANZFACILITY TYPE:
830
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
04/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Annabelle CalasanzTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Plan of Correction (POC) inspection. LPA met with Director Annabelle Calasanz and explained the reason for the inspection. The purpose of this inspection is the center was cited on 04/04/2023 for the LIC 9227: Individual Infant Sleeping Plan and Needs and Service Plan.

During today's inspection, LPA reviewed the LIC 9227 and the Needs and Service Plan for the infants. LPA discussed with Director that Section D also needs to be sign and dated by the parents. Director stated that she will have parents sign and date Section D and send proof to Licensing. Plan of corrections has been cleared.

LPA discussed with Director about water fountain that had an action level exceedance. Director stated that she will cover water fountain until test results that show that there is no action level exceedance. Facility will submit test result to Licensing.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Assistant Director Rocio Andrade. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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