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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406684
Report Date: 01/31/2023
Date Signed: 02/01/2023 03:17:45 PM


Document Has Been Signed on 02/01/2023 03:17 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:COMMUNITY BRIDGES VISTA VERDE CHILD DEV CENTERFACILITY NUMBER:
444406684
ADMINISTRATOR:MARIA HURTADOFACILITY TYPE:
850
ADDRESS:1936 FREEDOM BLVD.TELEPHONE:
(831) 724-3749
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY:32CENSUS: 14DATE:
01/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria Hurtado TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Elizabeth Larios, conducted unannounced Case Management visit in regards to a unusual incident that occurred on 10/27/2022. LPA was admitted into the facility by Program Manager, Maria Hurtado, and LPA explained purpose of the visit. Upon arrival there were 3 staff and 14 children present.

Upon arrival, LPA toured playground structure where unusual incident took place. LPA observed and measured the small opening with flat landing that is approximately three feet from the ground. Program Manger states the playground structure had a wiggle ladder that was remove due to wear and tear and was never replaced.

Type A deficiency was cited on the attached page (LIC 809-D). Exit interview conducted, appeal rights provided, and report was reviewed with Program Manager Maria Hurtado.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 02/07/2023 04:43 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/07/2023 10:45 AM

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: COMMUNITY BRIDGES VISTA VERDE CHILD DEV CENTER
FACILITY NUMBER: 444406684

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2023
Section Cited

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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Program Manger stated that the play structure will not be used until repairs are completed. Program Manager stated that a barricaded will be place and pictures will be submitted to CCL by POC due date 2/1/2023
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This requirement was not met as evidenced by: Based on observation, interviews and records reviews, center removed installed equipment and placed a mat that is not being used for the intended design,"wiggle ladder". LPA also consulted (Consumer Product Safety Commission Publication- Handbook for Public Playground Safety) for guidance and recommendation for fall height indicates it should not be more then 30 inches therefore LPA determined playground structure is a health and safety concern.
This poses an immediate threat to the health and safety of children in care.
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AB633 Parent Notification is required. According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this type A deficiency.

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2