434415730-4-28-2026-07-CC-JBER-DTKUNE-20260428154350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415730
Report Date: 04/28/2026
Date Signed: 04/28/2026 03:43:56 PM

Document Has Been Signed on 04/28/2026 03:43 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:	ESTRELLA FAMILY SERVICES @ GARDNER		FACILITY NUMBER:	434415730
ADMINISTRATOR/ DIRECTOR:	KRISTINE NGUYEN		FACILITY TYPE:	840
ADDRESS:	611 WILLIS AVENUE		TELEPHONE:	(408) 269-7827
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 49	CENSUS: 0	DATE:	04/28/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:14 PM
MET WITH:	Kristine Nguyen - Director		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/28/2026, Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Case Management/ Incident inspection. The reason for the visit was to investigate the self-reported incident that occurred on Thursday 04/23/2026. Upon arrival, LPA was greeted by the Director Kristine Nguyen and provided access to the facility. there was no children in care and there was two staff present (1 - Teacher/ 1 - Director). LPA conducted interviews with staff and collected relevant documentation. It was determined that Child #1 (C1) had their own prescribed medication on the elementary school campus when Staff #1 (S1) picked them up from the classroom for the after school program. C1 made S1 aware of the stored medication in C1's bag by telling her and shaking the medication bottle in front of other children in care. S1 requested C1 to put the medication inside the backpack until S1 could address the medication safely. C1's authorized representative arrived moments later to pick up C1. S1 had a brief discussion with C1's parent regarding the medication but due to S1's supervision responsibilities with the other children in care, the conversation was brief. The authorized representative stated they were unaware the child had medication with them. C1 left the campus with their authorized representative at that time and never attended the after school program on 04/23/2026. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: ESTRELLA FAMILY SERVICES @ GARDNER	FACILITY NUMBER: 434415730
	VISIT DATE: 04/28/2026

NARRATIVE

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On 04/27/2026, the facility staff called the Principal of Gardner Elementary School to notify the administration of the situation.

On 04/28/2026, the Director called C1's authorized representative to discuss the situation and determine what medication was in C1's possession and if it was prescribed. C1's authorized representative confirmed the medication was a prescription medication for C1 and most likely was given to the child by the father. Director relayed the protocol for storing and administering medication for C1 while they are on the school or facility campus.

LPA reminded facility staff that they are mandated reporters and required to report any suspected neglect or abuse. LPA requested a copy of the filed Child Protected Services (CPS) report after it had been submitted by the facility.

During today's inspection, LPA collected a copy of the facility sign in/out logs showing C1 did not enter the after school program on the day of the incident.

No deficiencies cited. Exit interview conducted with the Director. Report was reviewed and provided to Director Kristine Nguyen along with appeal rights.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC809 (FAS) - (06/04)

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