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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434410631
Report Date:
09/14/2021
Date Signed:
09/14/2021 03:27:55 PM
Document Has Been Signed on
09/14/2021 03:27 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:
GO KIDS CLUB @ SAN MARTIN GWINN
FACILITY NUMBER:
434410631
ADMINISTRATOR:
LAURA BEHL
FACILITY TYPE:
840
ADDRESS:
13745 LLAGAS AVENUE
TELEPHONE:
(408) 843-9000
CITY:
SAN MARTIN
STATE:
CA
ZIP CODE:
95046
CAPACITY:
60
TOTAL ENROLLED CHILDREN:
0
CENSUS:
16
DATE:
09/14/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Jennell Castillo
TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with director Jennell Castillo to amend a report dated 01/15/2020 and to clear a Plan of Correction for report dated 09/03/2021. LPA observed nine children with one teacher and one aid in room 1 and seven children with one teacher and one potential hire in room 2.
Facility was closed due to a positive Covid-19 case. Facility reopened on 09/07/2021. Director stated they met with the parent regarding the Plan of Correction but were unable to obtain further information as the child stopped attending on 08/24/2021. LPA observed facility is following title 22 regulations. No deficiency was cited.
Notice of site visit was issued and must be posted for 30 days.
SUPERVISORS NAME
:
Mary Segura
LICENSING EVALUATOR NAME
:
Deanna Villagrana
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/14/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/14/2021
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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