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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430709398
Report Date: 02/12/2026
Date Signed: 02/12/2026 02:20:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/12/2025 and conducted by Evaluator Darnella Barnes
COMPLAINT CONTROL NUMBER: 07-CC-20251212104005
FACILITY NAME:ADDISON PENZAK JEWISH COMMUNITY CENTERFACILITY NUMBER:
430709398
ADMINISTRATOR:CYNDI SHERMANFACILITY TYPE:
850
ADDRESS:14855 OKA ROADTELEPHONE:
(408) 357-7417
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:180CENSUS: 82DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Cyndi ShermanTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff commingle daycare children
INVESTIGATION FINDINGS:
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On February 12, 2026, Licensing Program Analyst Darnella Barnes conducted an unannounced complaint visit to deliver investigation findings regarding the allegation that toddlers and preschool-aged children were commingled during before and after school hours. Director Cyndi Sherman was informed of the visit’s purpose and granted access to the facility.

LPA completed a walkthrough of the indoor and outdoor areas. Present during the visit were the director, 23 staff, and 89 children.


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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20251212104005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ADDISON PENZAK JEWISH COMMUNITY CENTER
FACILITY NUMBER: 430709398
VISIT DATE: 02/12/2026
NARRATIVE
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Director was interviewed and provided information regarding classroom use during the before and after-school program. The director stated toddlers and preschool-aged children were commingled during these times. The director stated parent permission letters were on file to commingle toddlers and preschool-aged children. LPA observed parent permission letters. LPA informed the director of additional requirements for commingling children, as outlined in Provider Information Notice (PIN) 24-02-CCP, released 01/02/2024. On 01/07/2026, the director submitted a waiver request to the Department. The waiver was granted on 02/04/2026.

Based on LPAs observations, record review(s), and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

A “Type B” deficiency is issued on attached 809-D. Appeal rights provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Cyndi Sherman.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20251212104005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ADDISON PENZAK JEWISH COMMUNITY CENTER
FACILITY NUMBER: 430709398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2026
Section Cited
CCR
101216.4(a)(2)
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PRESCHOOL PROGRAM WITH TODDLER COMPONENT 101216.4(a)(2)...... 4(a) Licensees serving preschool-age children may create a special program component for children who are between 18 months and 36 months of age........(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children.....Plans to alternate use of outdoor play space must be approved by the Department.

This requirement was not met by:
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On 01/07/2026, the director submitted a waiver request to Licensing Department. The waiver was granted on 02/04/2026.
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Toddler and preschool children were commingled before and after school hours. The toddler program was not conducted in a physically separate area as required, and no waiver from Licensing was in place.
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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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3