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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410591
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:06:22 AM


Document Has Been Signed on 06/26/2024 11:06 AM - 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:ORCHARD, THEFACILITY NUMBER:
434410591
ADMINISTRATOR:PAMELA ERICKSONFACILITY TYPE:
850
ADDRESS:494 S. BERNARDO AVE.TELEPHONE:
(408) 789-2621
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:58CENSUS: 29DATE:
06/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria Roxanne ResumaTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Mel Matos met with Maria Roxanne Resuma, infant director, for a Plan of Correction (POC) inspection. The Facility was issued one "Type B" deficiency on June 14, 2024 per Section 101216.3(a) of Title 22 regulations as a result of an incident in which the Fig Room was out of ratio from 3:15 PM to 3:30 PM on Thursday June 6, 2024 when one teacher was alone in the Fig Room with 14 preschool children.

Maria Roxanne Resuma submitted a written Plan Of Correction (POC) to LPA Matos via email on Thursday June 20, 2024 outlining the procedures that have been implemented to ensure that the Facility maintains the required ratios at all times.

The Facility has thus completed the required Plan Of Correction (POC) and the Type B deficiency issued on June 14, 2024 is thus cleared as of today's inspection.

Exit interview conducted and report was reviewed with the infant director, Maria Roxanne Resuma. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024
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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