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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414640
Report Date: 07/22/2022
Date Signed: 07/22/2022 11:10:51 AM


Document Has Been Signed on 07/22/2022 11:10 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESAFACILITY NUMBER:
434414640
ADMINISTRATOR:CLAUDIA HERNANDEZFACILITY TYPE:
830
ADDRESS:196 MARTINVALE LANETELEPHONE:
(408) 644-7614
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY:14CENSUS: DATE:
07/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Shanean TonickTIME COMPLETED:
11:20 AM
NARRATIVE
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On 07/22/2022 at 10 :35 AM, Licensing Program Analyst (LPA), Susy Cervantes, met with office manager, Shanean Tonick, for a case management visit - incident, and explained the reason for the visit to them.

Previous to arrival, LPA observed that an incident that occurred on Monday 07/18/2022, had not been reported to the San Jose Regional Office in a timely manner, at arrival LPA was given the unusual incident report. LPA asked if the incident had been reported before today, office manager stated no.

Type B deficiency was cited during today's visit. Office manager was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed with the facility representative, Shanean Tonick. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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Document Has Been Signed on 07/22/2022 11:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CENTRO ARMONIA SPANISH SCHOOL-SANTA TERESA
FACILITY NUMBER: 434414640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2022
Section Cited

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Reporting Requirement 101212(d) Upon the occurrence... a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report... shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by:
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Based on record review and interview, the facility staff failed to report an incident that occurred on 07/18/2022 within a timely manner. This poses a potential risk to the health, safety, and personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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