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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703885
Report Date: 02/03/2025
Date Signed: 02/03/2025 11:15:49 AM

Document Has Been Signed on 02/03/2025 11:15 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:CALIFORNIA YOUNG WORLD # 5FACILITY NUMBER:
430703885
ADMINISTRATOR/
DIRECTOR:		ANGEL TORNOFACILITY TYPE:
850
ADDRESS:1110 FAIRWOOD DRIVETELEPHONE:
(408) 245-7285
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 104TOTAL ENROLLED CHILDREN: 86CENSUS: 46DATE:
02/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Angel TornoTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management inspection regarding an incident that was reported by the facility to Licensing. LPA met with Site Director, Angel Torno. LPA interviewed staff and reviewed records.

Based on the information from interviews and evidence gathered, on January 28, 2025, a parent (P1) of a preschool child was allowed to pick up child (C1) from the facility even though there was a protective order. Staff in the child's classroom were not aware of the protective order and allowed the child to leave with the parent. A copy of the protective order was submitted to the facility on the same day during drop off.

As a result of this inspection, Type A deficiency was cited on the following page.

Assembly Bill (AB) 633 was provided and discussed with Site Director. LPA informed the Site Director to provide a copy of this licensing report dated February 3, 2025 that documents a Type A citation to parents/guardians of all children currently enrolled no later than the next business day or the next day the children are in care, and to parents/guardians of any newly enrolled children for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224) must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Site Director, Angel Torno.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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 02/03/2025 11:15 AM - It Cannot Be Edited


Created By: Marilou Monico On 02/03/2025 at 10:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CALIFORNIA YOUNG WORLD # 5
FACILITY NUMBER: 430703885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2025
Section Cited
CCR
101223(a)(2)

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Personal Rights - (a) 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 Director states that she will submit a written POC to Licensing by 02/04/25 to ensure that this type of incident will not occur again in the future. Site Director states that a staff meeting will be conducted on 02/12/25 and children's personal rights will be discussed. Meeting agenda and proof of staff attendance will be sent to Licensing by 02/13/15.
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This requirement was not met as evidenced by: on 01/28/25, a parent (P1) of a preschool child was allowed to pick up child (C1) from the facility even though there was a protective order. This posed an immediate risk to the health, safety and personal rights to 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 Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


LIC809 (FAS) - (06/04)
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