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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710441
Report Date: 10/11/2024
Date Signed: 10/14/2024 11:38:37 AM

Document Has Been Signed on 10/14/2024 11:38 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROULEAU HEAD STARTFACILITY NUMBER:
430710441
ADMINISTRATOR/
DIRECTOR:		CUC TRANFACILITY TYPE:
850
ADDRESS:1875 MONROVIA DRIVETELEPHONE:
(408) 573-4717
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 105TOTAL ENROLLED CHILDREN: 50CENSUS: 14DATE:
10/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Rocio LitleTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 10/11/2024 at 12:55pm, Licensing Program Analyst (LPA) Farida Raja met with Director, Rocio Litle and conducted an unannounced Case Management inspection in response to an unusual incident that was self reported by the facility to Licensing on October 4th 2024. The alleged incident occurred on October 3rd, 2024 involving two preschool age children (C1 and C2). LPA obtained a copy of the Unusual Incident Report (LIC 624) for both children during today's visit.

Only one classroom was in session during today's inspection. LPA observed 13 children and 2 staff. Director stated that organization's Human Resources is conducting an internal investigation regarding the incidents and the investigation has not been completed at this time.

Further investigation is required. A follow up investigation will be conducted at a later date.

Exit interview conducted and the report was reviewed with the Director, Rocio Litle. No deficiencies cited during today's investigation.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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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