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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703784
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:37:09 PM

Document Has Been Signed on 07/14/2022 01:37 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:WEST VALLEY COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703784
ADMINISTRATOR:HORGAN, ANNEFACILITY TYPE:
850
ADDRESS:14000 FRUITVALE AVENUETELEPHONE:
(408) 741-2409
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 92TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
07/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anne HorganTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Pete Hernandez, met with Program Director, Anne Horgan for a Case Management - Incident and explained the purpose of the visit. The incident involved an unattended child left in a room by herself. This created an issue involving care and supervision. The incident occurred on 7/7/2022 involving a four and half year-old child. During today's inspection, LPA toured the facility, interviewed staff, reviewed a staff file, and obtained copies of documents. Based on available information,

A child was found alone in the classroom to recover a water bottle, possibly by one of the staff or the child let themselves in, and the classroom door was closed behind the child. The Teacher staff was outside. The staff that cooks was in the kitchen attached to the classroom and has no door but she was in another room with the door that was closed at the time. The Staff Cook observed the child alone and walked the child outside to join the Teacher Staff outside of the classroom. LPA was unable to determine how the child got in the room. Regardless of how the child got in the room, the child was lacking care and supervision.

LPA/s discussed the requirements of AB 633 with the Licensee/Director Anne Horgan and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee/Director understands the requirements. Upon receipt, Licensee/Director Anne Horgan 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 deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D, A violation regarding Care and Supervision warrants an immediate civil penalty of $500.00 and is hereby assessed, See LIC421IM . An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Anne Horgan, whose signature on this form confirm receipt of these documents.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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 07/14/2022 01:37 PM - It Cannot Be Edited


Created By: Pietro Hernandez On 07/14/2022 at 12:44 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: WEST VALLEY COLLEGE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430703784

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2022
Section Cited
CCR
101229(a)(1)

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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement was not met as evidenced by:
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Program Director provided they have submited a detailed plan to ensure that children are supervised at all times in the Self reported UIR.

Since this is a zero-tolerance violation, an immediate civil penalty of $500 was assessed during the inspection.
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A child left the playground and entered the classroom with out a Teacher being present in the classroom. This is a zero tolerance violation. This poses a immediate risk to the health and safety of children in care.
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Upon receipt, 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.

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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:Joel Segura
LICENSING EVALUATOR NAME:Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


LIC809 (FAS) - (06/04)
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