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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408785
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:03:31 AM


Document Has Been Signed on 11/21/2023 11:03 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:CKC CHILDREN'S CENTERFACILITY NUMBER:
444408785
ADMINISTRATOR:TINA BURCHERFACILITY TYPE:
850
ADDRESS:8005 WINKLE AVENUETELEPHONE:
(831) 475-6587
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:42CENSUS: 22DATE:
11/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tina Burcher & Kylie RobertsTIME COMPLETED:
11:23 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Tina Burcher, and Executive Director, Kylie Roberts, and explained purpose of visit, to follow-up on incident that occurred on 11/13/2023. Upon arrival, LPA was admitted into the facility by a staff member.

The facility self reported to the Department that on 11/13/2023, a child was left outside unattended during a transition from outside to inside, for less than one minute. The child was left outside in the gated play yard and was escorted back to the facility by a staff member from the elementary school (not a staff member from CKC).

LPA conducted interview with the Site Director to confirm details regarding the incident and review what follow-up has been done. Tina states that she has met with all staff members to review the importance of headcounts during transitions, giving reminders to the children about upcoming transitions, and utilizing walkie talkies to communicate with other staff members.

LPA informed Executive Director, Kylie Roberts, that this report dated (11/21/2023) documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Executive Director to provide a copy of this licensing report dated (11/21/2023) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of today's inspection, deficiencies have been cited, see LIC809-D.

Exit interview conducted and report was reviewed with Executive Director, Kylie Roberts.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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 11/21/2023 11:03 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: CKC CHILDREN'S CENTER
FACILITY NUMBER: 444408785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Since the incident occurred, the Site Director has met with all staff members regarding the importance of headcounts, utilizing walkie talkies, and giving children reminders prior to transitions.
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The Licensee did not ensure that children are visually supervised at all times as a child was left outside during a transition to inside, which poses an immediate risk to the health, safety, and personal rights of 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
LIC809 (FAS) - (06/04)
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