<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414596
Report Date: 09/08/2025
Date Signed: 09/08/2025 12:49:43 PM

Document Has Been Signed on 09/08/2025 12:49 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:CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTERFACILITY NUMBER:
444414596
ADMINISTRATOR/
DIRECTOR:		CYNTHIA EVANSFACILITY TYPE:
830
ADDRESS:305 ALTURAS WAYTELEPHONE:
(831) 462-9822
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 11DATE:
09/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Heidi ListerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPAs) Jaime Gonzales and Jennifer "Jen" Beehler conducted an unannounced Case Management - Incident inspection. LPAs were greeted and were let into the facility by Center Director Cynthia Evans. Upon arrival there were 11 children including five infants and six toddlers with four teachers.

LPAs observed the facility, interviewed staff and collected relevant documentation. Witness testimony revealed, on the date of the incident 09/04/2025, S1 had three children in the toddler playground. S1 picked up C2 so they could see their parent had arrived because they heard the sound of the truck. S1 moved to the back of the playground to address C3. S1's back was to C1 and C2. S1 turned around and observed the fence gate open to the parking lot. C2 was standing at the gate and C1 was not visible to S1. S1 ran to the gate and observed C1 running into the arms of their mother. C1's father addressed S1 and stated they would go into the facility to gather her belongings.

Facility added an additional lock to the top of the gate so that it can only be opened by an adult. Facility has planned a staff meeting for 09/08/2025 to review safety protocols. Facility has instituted a new policy that would prohibit staff and parents to use the side gate as a means to enter and exit the property. Signs will be posted at this location to advise all parties of the new policy.

Due to today's investigation one type A deficiency has been cited along with civil penalties. Further details are attached on the 809 D.

Continued on Page 2...
NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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)
Page: 2 of 4
Document Has Been Signed on 09/08/2025 12:49 PM - It Cannot Be Edited


Created By: Jaime Gonzales On 09/08/2025 at 11:40 AM
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: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2025
Section Cited
CCR
101429(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision for Infants 101429 (a)(1) In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation
1
2
3
4
5
6
7
Facility installed a lock at the top of the gate to ensure only adults can open and close the gate. Facility has scheduled a staff training for 09/08/2025 to address safety protocol. Facility to post signage regarding the gate usage change.
8
9
10
11
12
13
14
and supervision by a staff person at all times.
This requirement was not met as evidenced by:
S1's back was turned to C1 and C2. The gate to the parking lot opened without staff knowledge and C1 ran out of the facility. This poses an immediate risk to the health, safety, and personal right of children in care.
8
9
10
11
12
13
14
Facility to provide LPA with sign in sheet of training and a map showing staff positioning in both outdoor play areas when there is 1 staff : 4 children. Facility to provide photographic evidence to LPA by POC due date.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596
VISIT DATE: 09/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by authorized representatives and placed in the child's file within 24 hours of receipt of this report. A copy of the LIC9224 was given to Executive Director, Heidi Lister.

Exit interview conducted and report was reviewed with the Executive Director, Heidi Lister. Appeal Rights provided.

A notice of site visit was given to Executive Director, Heidi Lister and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4