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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415602
Report Date: 06/12/2024
Date Signed: 06/12/2024 09:49:51 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2024 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240416133316
FACILITY NAME:PEPPERTREE SCHOOLS RANCH HOUSEFACILITY NUMBER:
434415602
ADMINISTRATOR:DANNA D MATTHEW OSBORNFACILITY TYPE:
830
ADDRESS:14969 LOS GATOS ALMADEN ROADTELEPHONE:
(408) 626-9200
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:32CENSUS: 15DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Danna OsbornTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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- Staff does not ensure day care children's record files are up to date.
- Staff does not ensure facility follows an infection prevention plan.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced subsequent inspection to the facility to deliver findings on above allegations. LPA met with Director, Danna Osborn and explained the nature of today’s inspection to her.

Based on confidential interviews conducted with staff, reviewed children files and LPA's own observations, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12, Chapter 3), are being cited on the attached LIC 9099-D.

Two type "B" deficiencies were cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with and the report was giving to Director, Danna Osborn.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20240416133316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PEPPERTREE SCHOOLS RANCH HOUSE
FACILITY NUMBER: 434415602
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
101220.1(g)(1)
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Immunizations - The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.
(1) This requirement includes updating each child's immunization record when the child is due to receive required immunizations after enrollment in the child care center.
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Plan of Correction is required to submit to the office in written indicating methods and procedures implemented to ensure the facility stays in compliance with Tittle 22 for immunization records update,
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This requirement was not met as evidenced by LPA's record reviews did not observe the facility maintain updated immunization records for any infant in care immunization records due to receive required immunizations after enrolled. This posed an potential risk to the health and safety of children in care.
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as well as a discuss topic in the staff meeting with their attending signatures.
Type B
07/11/2024
Section Cited
CCR
101226.1(b)(2)
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Daily Inspection for Illness - (b) The licensee shall develop and implement a written inspection procedure that shall include the following: (2) The licensee shall require that the person bringing the child to the center remain until the child is accepted. (A) After the child has been determined to be without obvious signs of illness and has been accepted, the center shall require that the person sign the child in.
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Plan of Correction is required to submit to the office in written indicating methods and procedures implemented to ensure the facility stays in compliance with Tittle 22 for daily inspection for illness during drop-off and sign in procesures,
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This requirement was not met as evidenced by LPA's interviews with staff and LPA's own observation that the facility did not perform daily inspection for illness during the children drop-off as required by the regulations. This posed an potential risk to the health and safety of children in care.
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as well as a discuss topic in the staff meeting with their attending signatures.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2024 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240416133316

FACILITY NAME:PEPPERTREE SCHOOLS RANCH HOUSEFACILITY NUMBER:
434415602
ADMINISTRATOR:DANNA D MATTHEW OSBORNFACILITY TYPE:
830
ADDRESS:14969 LOS GATOS ALMADEN ROADTELEPHONE:
(408) 626-9200
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:32CENSUS: DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Danna OsbornTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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2
3
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9
- Staff do not provide adequate supervision to infants in care.
- Staff leave infants in gated area for an extended period of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced subsequent complaining visit to the Facility today to the facility to deliver findings on above allegations. LPA Huang met with Director, Danna Osborn and explained the nature of today's visit to her.

Based on interviewed with staff, reviewed children files, and LPA's own observations, the allegations listed above could not be proved or disproved.

LPA concludes that although the allegations may have happened or are valid, there were not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3