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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414441
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:28:01 PM

Document Has Been Signed on 05/12/2022 03:28 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:EDUCARE CALIFORNIA AT SILICON VALLEY HEADSTART/PSFACILITY NUMBER:
434414441
ADMINISTRATOR:MY NGUYEN-SOYFACILITY TYPE:
850
ADDRESS:1399 SANTEE DRIVETELEPHONE:
(408) 573-3340
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 173TOTAL ENROLLED CHILDREN: 116CENSUS: 93DATE:
05/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:My Nguyen-Soy & Elvira CortezTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA), Janette Cruz, met with My Nguyen Soy and Elvira Cortez, Directors, for an unannounced case management inspection in response to a self-reported Unusual Incident that the Facility reported to the Department via telephone on 05/09/22.

The Unusual Incident occurred on 05/05/22 when a garden worker informed the Director that she saw a staff (S1) helping a child (C1) to exit the garden by pulling the child on the wrist. Director stated that the garden worker described what she witnessed as concerning because C1 looked a bit distressed and was asking to be let go. Director stated that she interviewed S1 who told her that she was helping the child exit the garden only by holding his hand. Director stated that she did not see any marking on the child, nor the child mentioned anything about wrist pulling.

Director stated that the garden worker is not available for an interview during today's inspection. Director stated that garden worker is employed by California Native Garden Foundation, who provides garden experience classes to the children enrolled in the facility. Director provided contract service agreement of California Native Garden Foundation with Educare and garden worker's contact information.

LPA conducted additional staff and children's interviews who were present during the incident. LPA also reviewed the staff and children's records on facility file.
Based on the available information, Further investigation is required and shall be continued on a later date.

Exit interview was conducted with Directors, My Nguyen Soy and Elvira Cortez.

A Notice of Site Visit was issued and must be posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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