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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444412727
Report Date: 02/06/2020
Date Signed: 02/06/2020 11:02:39 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:CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.FACILITY NUMBER:
444412727
ADMINISTRATOR:CHANDRA PORTERAFACILITY TYPE:
850
ADDRESS:4510 JADE STREETTELEPHONE:
(831) 475-5188
CITY:CAPITOLASTATE: CAZIP CODE:
95010
CAPACITY:60CENSUS: 38DATE:
02/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Carly Fuhrman and Lisa PorschTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Incident. LPA met with Director Carly Fuhrman and explained the reason for the inspection. Preschool Program Director Lisa Porsch arrived shortly after. The purpose of this inspection is to follow up in regards to an incident that occurred on 01/15/2020 that involved C-1. This resulted in C-1 having a broken femur bone.

LPA inspected the physical plant. LPA also interviewed staff and children. LPA also reviewed and obtained a copy of the accident report. Based on the information obtained, staff were able to provide aid at the time of the incident. Parents were also notified of the incident.

As a result of this inspection, no deficiencies have been cited. An exit interview was conducted where this report was discussed and provided to Director Carly Fuhrman. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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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