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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444411594
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:57:29 PM


Document Has Been Signed on 06/15/2023 12:57 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:ENCOMPASS HEAD STARTFACILITY NUMBER:
444411594
ADMINISTRATOR:SUZANNA LOPEZFACILITY TYPE:
850
ADDRESS:6500 SOQUEL DRIVE, BLDG. 1700TELEPHONE:
(831) 477-5275
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:28CENSUS: 3DATE:
06/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Suzanna Lopez, Arienya "Bryce" Christerson, & Corey Vestal TIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Marilou Monico and Jovani Dillon, conducted an unannounced Case Management Inspection. LPAs met with Teacher/Director, Suzanna Lopez, Comprehensive Services Manager, Corey Vestal, and Site Supervisor, Arienya "Bryce" Chisterson. LPA Monico learned from interviews that a child's (Child #1's) arm was pinched by staff (S-1).

Deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Comprehensive Services Manager, Corey Vestal.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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 06/15/2023 12:57 PM - 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: ENCOMPASS HEAD START
FACILITY NUMBER: 444411594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights - The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Site Supervisor stated that she will submit a written plan by 06/16/23 to Licensing detailing the steps the facility are planning to take to ensure that children's personal rights are not violated.
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This requirement was not met as evidenced by: A staff member (S-1) pinched Child #1's arm. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
LIC809 (FAS) - (06/04)
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