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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408763
Report Date: 03/05/2025
Date Signed: 03/06/2025 04:38:11 PM

Document Has Been Signed on 03/06/2025 04:38 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:BOWERS CHILD DEVELOPMENT INFANT PROGRAMFACILITY NUMBER:
434408763
ADMINISTRATOR/
DIRECTOR:		DAISY CANOFACILITY TYPE:
830
ADDRESS:2755 BARKLEY AVENUETELEPHONE:
(408) 423-1115
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 12TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Daisy CanoTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
NARRATIVE
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On 3/5/25, Licensing Program Analyst (LPA) Anna Morales conducted a Case Management inspection in response to an Unusual incident that was self- reported by the facility to Licensing on 2/26/25. LPA met with Director Daisy Cano, and explained the purpose for the visit.

Based on available evidence and interview, it was determined that on 2/24/25, Staff (S2) administered Child(C1)medication in error at 12:40pm. The Director stated that Child(C1) parent(s) were notified, and Child(C1) was monitored until Child(C1) was picked up by the Parent(s) at 3:13pm. Director stated that Child(C1)returned to the facility on the following day, 2/25/25.

As a result of this inspection, A Type B citation was issued at today's visit.

An exit interview was conducted, and Plan of Corrections were reviewed with the Director Daisy Cano.

A notice of site visit has been issued and must remain posted for 30 days. Appeal Rights Given.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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 03/06/2025 04:38 PM - It Cannot Be Edited


Created By: Anna Morales On 03/05/2025 at 10:48 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: BOWERS CHILD DEVELOPMENT INFANT PROGRAM
FACILITY NUMBER: 434408763

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2025
Section Cited
CCR
101226(e)(3)(A)

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101226(e)(3)(A):Health Related Services:
(e) In centers where the licensee chooses to handle medications:(3)Prescription medications may be administered if all of the following conditions are met:
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Director stated that she will submit a plan to ensure that the children's medications are administered in accordance with the label directions as prescribed by the Child's physician by the POC date.
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(A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement was not met as evidenced by: On 2/24/25,at 12:40pm Staff(S2)administered Child(C1)medication in error, which poses a potential 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:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
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