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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410606
Report Date: 05/16/2024
Date Signed: 05/16/2024 12:06:37 PM

Document Has Been Signed on 05/16/2024 12:06 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:SAN ANTONIO HEAD STARTFACILITY NUMBER:
434410606
ADMINISTRATOR/
DIRECTOR:
GLADYS ENGFACILITY TYPE:
850
ADDRESS:1803 STOWE AVENUETELEPHONE:
(408) 573-4001
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 32DATE:
05/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Gladys EngTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 5/16/24 LPA Sheena Chin conducted an unannounced Case Management - Incident inspection to the facility in response to incidents that occurred on 4/30/24 and on 5/6/24. LPA met with the director, Gladys Eng and explained the purpose of the visit.

On 4/30/24 the facility reported that the child, C1, came to school with live roaches in both of his shoes and that the child has been coming to school with dirty clothes. The director stated that staff removed the child’s shoes and washed the child's shoes to make sure they are clean and safe to wear. The director stated that staff tried to contact the grandfather, but phone was not answered. The director stated that staff reported the case to Child Protective Services (CPS) and the licensing department.

On 5/6/24 the facility reported that the child, C1, had bit marks on his body, which looked like bed bugs. The director stated that staff found blood on the child’s lower back and then learned that the child was scratching the marks, which caused him to start bleeding. The director stated that staff cleaned the child and reported it to CPS and the licensing department.

The director stated that a social worker currently is working with the child’s guardian to ensure the health of the child. The director stated that the child has not had any hygiene issues since the incidents.

No regulatory violations were observed during today’s inspection.

Exit interview was conducted, and the report was reviewed with the director, Gladys Eng.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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