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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703885
Report Date: 10/05/2023
Date Signed: 10/05/2023 01:33:03 PM


Document Has Been Signed on 10/05/2023 01:33 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:CALIFORNIA YOUNG WORLD # 5FACILITY NUMBER:
430703885
ADMINISTRATOR:ANGEL TORNOFACILITY TYPE:
850
ADDRESS:1110 FAIRWOOD DRIVETELEPHONE:
(408) 245-7285
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:104CENSUS: 26DATE:
10/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Angel TornoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Angel Torno, director, for an unannounced case management investigation in response to a self reported incident report that the Facility self reported to the Department.

The Unusual Incident occurred on September 5, 2023 at approximately 5:30 PM. Director states that the grandmother of one preschool child complained that one preschool staff was "too aggressive" with the preschool child. Director states that the incident involved a staff person putting her arm around the right shoulder of the preschool child to guide the child back to the classroom. The preschool child had seen the child's grandmother outside the classroom at the time of the incident and wanted to go see her before the grandmother had signed the child out. There were four preschool children with one teacher and one aide in the classroom at the time of the incident. Director states that staff are not supposed to let the preschool children leave the classroom before they are signed out.

Director states that an older sibling of the preschool child also observed the incident and noted that the staff guided the child back to the class, but that it was not in an aggressive manner. Director states that the preschool child was fine and did not complain about the staff to her. Director states that she spoke with the child's grandmother, mother, and preschool staff about the incident.

Director states that she couldn't conclude if the staff had been "too aggressive" with the preschool child. Director states that the staff indicated that she was simply trying to keep the child from leaving the classroom. Director states that she provide alternative methods to the staff for dealing with children in similar situations. Director states that the child is still enrolled at the Facility and is doing fine.

Based on the available evidence, LPA concludes that there is insufficient evidence to prove that the alleged allegation did or did not occur. Exit interview conducted and report was reviewed with Angel Torno, director, and advised her that no deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023
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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