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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400316
Report Date: 08/11/2021
Date Signed: 08/11/2021 04:00:41 PM

Document Has Been Signed on 08/11/2021 04:00 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LITTLE SONSHINE SCHOOLHOUSEFACILITY NUMBER:
434400316
ADMINISTRATOR:SULLIVAN, YOLANDAFACILITY TYPE:
850
ADDRESS:16970 DEWITT AVENUETELEPHONE:
(408) 779-6788
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 53TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Yolanda SullivanTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Yolanda Sullivan in the school hallway outside of the classrooms for a case management visit. Present were licensee, teacher Lipsa Rath, teacher Casie Piccardo, a parent volunteer Ana Toro, Ana's three children in room 2 and five day care children in room 4.

LPA observed teacher Lipsa Raph is not associated to the facility and has been employed since 06/14/2021. LPA observed parent/volunteer Ana Toro did not have fingerprint clearance. Yolanda stated Ana is a helper and gives her a break for an hour. Ana Toro was observed in room 2 filling up a water container. When licensee Yolanda and LPA walked into room 4 where children were napping, LPA observed five children awake laying on their mats with no supervision. LPA informed licensee Yolanda that Ana can only care for children if she is fingerprint cleared and children are asleep. Yolanda informed Ana who then left they facility during the visit.

LPA discussed the requirements of AB633 to licensee Yolanda Sullivan and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements. Upon receipt, licensee Yolanda shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

The following type A deficiencies were cited on the attached page (809-D). Licensee Yolanda was informed that failure to correct the deficiencies 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. Civil Penalties in the amount of $1,100 were assessed during the visit for fingerprint clearance and lack of supervision.

A Notice of Site was issued and must be posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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 3
Document Has Been Signed on 08/11/2021 04:00 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 08/11/2021 at 02:31 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: LITTLE SONSHINE SCHOOLHOUSE
FACILITY NUMBER: 434400316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2021
Section Cited
CCR
101170(e)(2)

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Request a transfer of a criminal record clearance as specified in Section101170(f). This requirement was not met as evidenced by Lipsa Rath is not associated to the facility and has been employed since 06/14/2021.
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Licensee Yolanda will ensure teacher Lipsa Rath is associated to the facility before allowing her to return and work with children.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Type A
08/12/2021
Section Cited
CCR101170(e)(1)

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Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA observed parent/volunteer Ana Toro did not have fingerprint clearance.
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Licensee Yolanda asked Ana to leave and she took over in the classroom. Yolanda will submit a letter to CCL stating she understands individuals shall be cleared prior to working with children.
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Yolanda stated Ana is a helper and gives her a break for an hour.
This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/11/2021 04:00 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 08/11/2021 at 02:49 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: LITTLE SONSHINE SCHOOLHOUSE
FACILITY NUMBER: 434400316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2021
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Licensee Yolanda will submit a letter to CCL stating she understands children shall be supervised at all times. Letter must be submitted by end of business 08/12/2021.
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This requirement was not met as evidenced by LPA observed five children awake laying on mats with no supervision. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


LIC809 (FAS) - (06/04)
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