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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415566
Report Date: 10/26/2021
Date Signed: 10/26/2021 10:49:13 AM

Document Has Been Signed on 10/26/2021 10:49 AM - 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:SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434415566
ADMINISTRATOR:PATRICE KELLEYFACILITY TYPE:
850
ADDRESS:1835 CUNNINGHAM AVENUETELEPHONE:
(408) 928-5260
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 0DATE:
10/26/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Melissa Leza & Patrice KelleyTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Janette Cruz, and Licensing Program Manager (LPM) Diana Stephenson, conducted a scheduled informal office meeting at the San Jose Regional Office with Melissa Leza, Program Director and Patrice Kelley, Director. The purpose of today's meeting was to discuss care and supervision in a child care center.

The Facility was issued one "Type A" deficiency on September 15, 2021 Section 101229(a)(1) Care and Supervision - of Title 22 regulations as a result of absence of care and supervision where a preschool child was left unattended in the preschool playground for approximately 5 minutes on 09/01/21.


LPM explained to the Program Director and Director that if there are continued deficiencies cited for absence of care and supervision, the Facility may be referred to legal for possible administrative action, which could include revocation of the Facility license. The Facility will be monitored more frequently to ensure that the Facility is in compliance with the Department regulations.

On 9/15/21, Licensee had submitted a written plan stating that facility shall ensure proper supervision of children at all times and conducted staff training on 9/9/21. LPA and LPM reminded that Licensee needs to be in compliance with care and supervision wherein no child(ren) shall be left without supervision, including visual observation, of a teacher at any time.

Exit interview was conducted with Melissa Leza and Patrice Kelley.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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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