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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444404901
Report Date: 11/19/2025
Date Signed: 11/19/2025 01:13:24 PM

Document Has Been Signed on 11/19/2025 01:13 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:CIRCLE OF FRIENDSFACILITY NUMBER:
444404901
ADMINISTRATOR/
DIRECTOR:		STACEY BOTKINFACILITY TYPE:
850
ADDRESS:111 NORTH NAVARRA DRIVETELEPHONE:
(831) 461-1366
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY: 39TOTAL ENROLLED CHILDREN: 39CENSUS: 34DATE:
11/19/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Stacy Bot KinTIME VISIT/
INSPECTION COMPLETED:
01:22 PM
NARRATIVE
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On 11/19/2025, Licensing Program Analyst (LPA), Jaime Gonzales was greeted by Site Director Stacy Botkin and LPA stated that the purpose of todays visit was to conduct an unannounced Annual/Random Inspection. LPA provided Site Director with the Entrance Checklist (LIC 125). LPA was granted access to the facility and toured both indoors and outdoors during the inspection. Upon arrival, LPA completed a census head count in preschool classrooms. The green room had 10 preschoolers and one staff. The Blue room had 12 preschoolers and two staff. The red room had 12 preschoolers and two staff.

LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Thursday 07:30AM-5:15PM. There are no active waivers on file. The preschool program serves children ages 2 years to Kindergarten. The facility transports children and the person transporting has a valid license.

The classrooms have age-appropriate materials, toys, furnishing, equipment. Storage for children’s belongings in outdoor covered entryway. The children's napping equipment were observed to be stored in a healthful manner. Bedding is provided by the center and is washed weekly or as needed. LPA observed fully charged 2A10BC fire extinguisher, functioning smoke and carbon monoxide detectors. The isolation area for sick children is the building entryway or office. LPA observed that the a section of the floor near the door that leads to outside is being replaced in the Red room and Blue room. LPA did not observe any hazards. LPA and Site Director discussed reporting requirements for any future alterations or constructions to the facility.

Lunch is provided by the parents. Facility offers full day program and provides midmorning snack and afternoon snack to children. The menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use. LPA and Site Director discussed the type of milk to be served at the facility.
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NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/19/2025 01:13 PM - It Cannot Be Edited


Created By: Jaime Gonzales On 11/19/2025 at 12:26 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: CIRCLE OF FRIENDS
FACILITY NUMBER: 444404901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(g)
Outdoor Activity Space
(g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above due to The outdoor play had one wood board that is to the right of the sandbox and has a hole at the bottom of the fence which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/03/2025
Plan of Correction
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Site Director to send a picture of the fence board replaced by POC due date 12/03/2025.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to Site Director, Staff (S1, S2, S3 and S5) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/03/2025
Plan of Correction
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Site Director will provide copies of mandated reporter training for Director, Staff (S1, S2, S3 and S5) to the department by POC due date 12/03/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Deanna Villagrana
NAME OF LICENSING PROGRAM MANAGER:
Jaime Gonzales
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: CIRCLE OF FRIENDS
FACILITY NUMBER: 444404901
VISIT DATE: 11/19/2025
NARRATIVE
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Trash cans for the disposable of solid wastes are equipped with tight fitting lids. Drinking water is readily available for children in via water bottles from home labeled with the children’s names. In addition, the facility provides filtered water to refill the children's water bottles. The outdoor play had one wood board that is to the right of the sandbox and has a hole at the bottom of the fence. Site Director will have this replaced. Shade is provided by trees and canopies. All equipment and surfaces are free from hazards. There are no bodies of water on the premises. There are age-appropriate outdoor toys and materials for the children. LPA observed a climbing structure with sufficient resilient material under and around the structure. Per Site Director, there are no firearms or weapons on the premises. All individuals subject to criminal record review have fingerprint clearances and associated to the facility. At least one staff member has a current Pediatric CPR/First-Aid certification. Fire/disaster drill was conducted in May 2025. LPA reviewed sign-in/out sheets, facility roster (LIC9040).

LPA reviewed 5 random children files during today's inspection for the following records: Admission Agreement, Personal Rights (LIC 613A), Identification and Emergency Information (LIC 700), Notification of Parents Rights (LIC 995A), Consent for Emergency Medical Treatment (LIC 627), Physician’s Report with TB test (LIC 701).

LPAs reviewed five 5 staff files for the following records: Health Screening Report (LIC 503), TB Test, Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee rights (LIC 9052), staff qualifications. Site Director and Staff (S1, S2, S3 and S5) are all missing mandated reporter training certificates in their files. Site Director was reminded of their responsibility to renew CPR/First Aid and Mandated Reporter Training every two years.

Site Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. .
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NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: CIRCLE OF FRIENDS
FACILITY NUMBER: 444404901
VISIT DATE: 11/19/2025
NARRATIVE
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For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

LPA reminded Site Director to report unusual incidents or injuries to children in care to the Department of Social Services using the Unusual Incident/Injury Report form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 calendar days.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Site Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, there were deficiencies cited.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Director, Stacy Botkin.
NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC809 (FAS) - (06/04)
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