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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404385
Report Date: 02/06/2025
Date Signed: 02/06/2025 02:07:59 PM

Document Has Been Signed on 02/06/2025 02:07 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:SJB - NORTHWOOD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404385
ADMINISTRATOR/
DIRECTOR:		MARIA VELAZQUEZFACILITY TYPE:
850
ADDRESS:2760 TRIMBLE ROADTELEPHONE:
(408) 719-1319
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 15DATE:
02/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Maria VelazquezTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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At 8:45 AM, Licensing Program Analysts (LPAs) Andy Yang, Angela Luz and Licensing Program Manager (LPM) Belinda Devall met with Director, Maria Velazquez, for an unannounced case management incident. Purpose of today's inspection: discuss an incident report that the Facility self reported of an incident that occurred on 1/14/2025. LPAs toured the indoor area of the facility, Classroom 700 (Toddler), Classroom 601 & 602 (Pre-K), and outdoor area. The facility operates in (2) portable classrooms on campus of Northwood Elementary School. The hours of operation are from Monday to Friday, 7:00 AM to 6:00 PM. There were (18) children and (9) teachers present, and were within ratio.

During today's investigations, LPA reviewed two staff (S1 & S2) files for teachers' qualifications.

Based on interviews conducted, Child (C1) left the play area by exiting the interior gate next to the preschool portable classroom without supervision. Staff realized the child had left the play area and was located in the outdoor area near 601/602 and was brought back to the play area with the rest of the children.

One Type B deficiencies was issued during today's investigation.

A notice of site visit and appeal rights were given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Maria Velazquez.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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 02/06/2025 02:07 PM - It Cannot Be Edited


Created By: Andy Yang On 02/06/2025 at 12:12 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: SJB - NORTHWOOD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2025
Section Cited
HSC
101229(a)(1)

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Responsibility for Providing Care and
Supervision: 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. Supervision shall include visual observation.
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Director will submit copy of training plan on playground zoning, active supervision, and process for teacher transtion when dealing with children with challenging behaviors. Train the staff on new playground supervision procedures, and provide copy of attendance sheet for the staff training.
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This requirement was not met as evidenced by:
Based on interviews, and evidence gathered, Child (C1) was found outside of the play area alone without any supervision. This poses an potential risk to the health, safety and personal rights of 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:Belinda Devall
LICENSING EVALUATOR NAME:Andy Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


LIC809 (FAS) - (06/04)
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