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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412402
Report Date: 08/14/2020
Date Signed: 08/14/2020 04:14:29 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:SCUTTLEBUGS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434412402
ADMINISTRATOR:LINDA WHITEFACILITY TYPE:
830
ADDRESS:3291 STEVENS CREEK BLVDTELEPHONE:
(408) 564-5356
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:38CENSUS: 9DATE:
08/14/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Samantha Case Penman & Linda WhiteTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Mel Matos conducted an announced case management tele-visit inspection via FaceTime (#408-510-1565) with Samantha Case Penman, Licensee representative, and Linda White, director. Samantha and Linda were informed that due to COVID-19 the Facility Evaluation Report (LIC 809) will be emailed to the Facility (email: lindaw@scuttlebugscdc.com) and the Facility reply to the email within 24 hours will serve as acknowledgement that today's report was received.

Purpose of today's case management tele-visit inspection: verify that Robert Haugh, employee, is no longer working/present in the Facility. Per Samantha and Linda, Robert Haugh worked as a preschool teacher from September 3, 2019 to June 26, 2020. Samantha and Linda states that Robert Haugh resigned. Reason for resignation was not provided.

LPA advised Samantha and Linda that a copy of the "Order to Licensee/Facility of Immediate Exclusion from Facility" for Robert Haugh will be emailed to the Facility along with today's report.

No deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, EMAILED TO THE FACILITY, 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: 08/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020
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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