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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407992
Report Date: 01/14/2020
Date Signed: 01/14/2020 03:32:32 PM

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:NEIGHBORHOOD CHRISTIAN CENTERFACILITY NUMBER:
434407992
ADMINISTRATOR:MARQUES-HAHN, G.FACILITY TYPE:
850
ADDRESS:887 POMEROY AVENUETELEPHONE:
(408) 984-3418
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:155CENSUS: 132DATE:
01/14/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Jessica FraserTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Shannel Reed met with Program Director, Jessica Fraser, for a case management inspection to follow-up on the unusual incident report (UIR) the Director self-reported to and received by Licensing on 11/15/19. There were 132 children with 30 Teachers in the preschool program.

The incident reported was regarding a child (C-1) arriving home with ink (red marker) scribbles on her upper right thigh and a missing undergarment. It was reported that C-1 arrived home and while getting ready for bath time, C-1’s parent observed that C-1 had red scribble marks on the right thigh and the daily undergarment was missing. C-1’s parent stated that C-1 was also unsure where the undergarment had gone. Based on interviews with staff and C-1 it is unlikely that C-1 was unsupervised while at the day care center. No staff observed the C-1 scribble on their leg or remove the undergarments. Surveillance video was unavailable to view at this time, as the persons able to retrieve the video are unavailable at this time. The Program Director stated that she would have it sent to the CCL office by Friday, 01/17/20.
Based on the interviews conducted and the information obtained, LPA has determined that no regulatory violation has occurred at this time.

No Title 22 Deficiencies were cited during today’s inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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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