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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415767
Report Date: 06/16/2021
Date Signed: 06/16/2021 04:49:44 PM

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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
434415767
ADMINISTRATOR:SHAYLYNN LUCASFACILITY TYPE:
850
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:96CENSUS: 45DATE:
06/16/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Annabelle CalasanzTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Legal/Non-complicance inspection. LPA met with Director Annabelle Calasanz and explained the reason for the inspection. The purpose of this inspection is to ensure that facility is adhering to plan of correction implemented during the Non-Compliance Conference held on 04/29/2021 in regards to providing care and supervision and health-related services.

LPA toured the facility and observed that staff were positioned where they can visual supervise children. LPA discussed with Director Annabelle about training conducted. Director stated that they have done training with staff on 06/2021 and on 02/2021 in regards to supervision. Director also stated that she will conduct monthly training and weekly check-in with staff. Director also stated that Program Coordinator, Brandi Santos, conducted a safety check of the facility on 06/16/2021.

LPA reviewed facility roster printed on 06/15/2021. S-1 has fingerprint clearance, but was not associated to the facility. LIC 9182 was submitted for S-1 on 09/2020 and received confirmation. Director resubmitted LIC 9182 with a valid ID.

As a result of this inspection, no deficiencies have been cited. An exit interview was conducted where this report was discussed and provided to Director Annabelle Calasanz. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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