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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415603
Report Date: 07/20/2023
Date Signed: 07/20/2023 09:44:29 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
07/19/2023 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230719142646
FACILITY NAME:PEPPERTREE SCHOOLS COTTAGE HOUSEFACILITY NUMBER:
434415603
ADMINISTRATOR:THERESA BECKERDITEFACILITY TYPE:
850
ADDRESS:16035 LOS GATOS ALMADEN ROADTELEPHONE:
(408) 356-3211
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:36CENSUS: 28DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jo-Ann Pagan & Danna OsbornTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility providing care in care in a room that is not fire cleared.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kassandra Medrano made an unannounced initial10-day visit and met with Licensee/Director, Danna Osborn, and Co-Director, Jo-Ann Pagan. The purpose of the inspection was explained. LPA Medrano toured the facility and inspected for health and safety hazards.

During the investigation, LPA conducted staff interviews and made classroom observations. At 8:34am, LPA observed the "classrooms separate" and observed 6 children and staff, S6 enter the classroom named "club house" which is the classroom that is located separate from the main building closest to the yards. The club house was previously cleared by fire for school age children but has not received fire clearance for the ages that are served on this preschool license.This poses an immediate health and safety risk to children in care due to this space not receiving fire clearance from Santa Clara County Fire for the children enrolled. Based on observations and staff interviews a type A deficiency will be cited today, and a civil penalty is being issued.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS. LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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 2
Control Number 07-CC-20230719142646
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 COTTAGE HOUSE
FACILITY NUMBER: 434415603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/20/2023
Section Cited
CCR
101171(a)
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101171 Fire Clearance(a) All child care centers shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
This requirement was not met as evidenced by:
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Licensee, Danna Osborn stated that children will not be in the uncleared space until Santa Clara County Fire has given the space clearance. Licensee to send documentation of clearance. During todays inspection children were immediatley moved.
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Based on interviews and observations, it was found that the facility was operating within the "club house" which has not received fire clearance for the children that are in care.

This poses an immediate health and safety risk to children 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.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2