<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410811
Report Date: 05/22/2019
Date Signed: 05/22/2019 11:49:52 AM

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 REDWOOD MOUNTAIN CHILD DEV CTRFACILITY NUMBER:
444410811
ADMINISTRATOR:CATHERINE KRENNFACILITY TYPE:
850
ADDRESS:7103A HIGHWAY 9TELEPHONE:
(831) 335-3222
CITY:FELTONSTATE: CAZIP CODE:
95018
CAPACITY:20CENSUS: 6DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Catherine KrennTIME COMPLETED:
11:49 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A visit was made by Analyst Behbood to follow up on a self reported incident occurred on 04/12/19. Purpose of visit explained. Catherine is the only staff at the facility due to low enrollment. Analyst talked to Catherine between activities and basically she reiterate what has been reported already. Analyst took her statement, reviewed child's health history both filed by parents and physician. Analyst also examined the blocks. On the day of incident 8 children were present. So it appears that the incident was accidental and not caused by lack of supervision.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 1