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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400029
Report Date: 09/13/2024
Date Signed: 09/13/2024 03:03:11 PM

Document Has Been Signed on 09/13/2024 03:03 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHRISTOPHER RANCH HEAD STARTFACILITY NUMBER:
434400029
ADMINISTRATOR/
DIRECTOR:		ANGELICA GUZMANFACILITY TYPE:
850
ADDRESS:305 BLOOMFIELD AVENUETELEPHONE:
(408) 453-6900
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 48TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Rocia, LitleTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On 9/13/2024, at 1:45 PM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conduct a Case Management Inspection and was greeted by Rocia, Litle, Director and informed her the reason for inspection.

The department received an incident report dated for 9/10/2024 regarding an incident with a child being left unsupervised outside of the classroom on 9/9/2024. Supervisor, Emma Morica, notified CCL about the incident.

During the course of the investigation, LPA interviewed the director, Rocia, Litle. Director stated that Child 1 (C1) was washing his hands, and he got his jacket wet. C1 told Ms. Moreno that he got his jacket wet after washing his hands, and Ms. Hangelica asked Ms. Moreno to hang C1’s jacket outside. During the time the staff had the door open, C1 walked outside, and staff did not notice. Ms. Moreno proceeded to closed to door behind her. While the other children were sitting down at the table preparing for breakfast, Ms. Sandra was conducting a roll call with all the children and noticed C1 was not present. Ms. Hangelica immediately opened the door and seen C1 standing outside in the sun trying to dry his pants. Director stated she is doing reprimands.

The following type A deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.



A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted with Director, and a copy of this report review and provided along with appeal rights.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/13/2024 03:03 PM - It Cannot Be Edited


Created By: Liridon Fici On 09/13/2024 at 02:38 PM
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: CHRISTOPHER RANCH HEAD START
FACILITY NUMBER: 434400029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision : (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time...
This requirement is not met as evidenced by:
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Director agreed, starting September 19, 2024, teachers will be attending training for active supervision prodeedures, and this will be on-going monthly. Side director will be monitoring training on a hourly basis which includes out child supervision policy, prodeedues and responibilities of our active supervision protocal.
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Based on interview, the licensee did not comply with the section cited above by leaving C1 unsupervised and unattended outside of his classroom which poses an immediate health, safety or personal rights risk to persons 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Liridon Fici
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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