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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404978
Report Date: 01/06/2025
Date Signed: 01/06/2025 12:03:54 PM

Document Has Been Signed on 01/06/2025 12:03 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:LOS ARROYOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404978
ADMINISTRATOR/
DIRECTOR:		OKSANA OKSFACILITY TYPE:
850
ADDRESS:885 MORO DRIVETELEPHONE:
(408) 843-9005
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 96TOTAL ENROLLED CHILDREN: 63CENSUS: 36DATE:
01/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:OKSANA OKSTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 1/6/2025, at 10:24 AM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conduct a Case Management Inspection and was greeted by OKSANA OKS, Director at the front door. LPA informed Director the purpose of today’s visit.

During visit, LPA interviewed director and director stated on 12/17/24, during transitioning time from outside to inside, staff made a head count and counted all the children including C1, however, after C1 was counted, C1 ran and hid under the slide where staff did not see where she was. Staff closed the door, leaving C1 outside. Staff peeked through the door window, seeing C1 standing outside alone. Staff Maria Coria- Master Teacher, Monica Uribe- Teacher Assistant, Brenda Suarez- Teacher witnessed child being left outside and brought the child in and informed Director about the incident. After the incident on 12/17/24, the Director scheduled and had a meeting with the staff involved in the incident on 12/17/2024 regarding head count of supervision, reviewing policies and procedures on head count and supervision, to ensure steps are being followed at all times. The following day, 12/18/24, Director met with the same staff again to go over-active supervision training and to complete some exercises along with self-reflection tool on active supervision practices. On 12/20/2024, an all-center staff meeting was scheduled to review head count and supervision policies and prosecutes.



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 civil penalty of $500 is being assessed today during inspection.

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

Exit interview conducted with Director, and this report reviewed and provided along with appeal rights.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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 01/06/2025 12:03 PM - It Cannot Be Edited


Created By: Liridon Fici On 01/06/2025 at 11:40 AM
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: LOS ARROYOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2025
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 stated she conducted training on 12/17/2024 and 12/18/2024 for staff involved in the incident dated for 12/17/2024 on head count of supervision, reviewing policies and procedures on head count and supervision along with active supervision...
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Based on interview and record review, the Director did not comply with the section cited above by leaving a child unattented and unsupervised alone outside of C1's class which poses a potential health, safety, or personal rights risk to persons in care.
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On 12/20/2024, an all staff center training was conducted to review head count and supervision policies and procedures.
Director submitted proof of training which were signed and dated by all staff who work at the center.
Deficiency Cleared

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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: 01/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2025


LIC809 (FAS) - (06/04)
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