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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417135
Report Date: 10/23/2025
Date Signed: 10/23/2025 03:34:30 PM

Document Has Been Signed on 10/23/2025 03:34 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:TESSELLATIONS CHILDREN'S CENTERFACILITY NUMBER:
434417135
ADMINISTRATOR/
DIRECTOR:		MATT LINDENFACILITY TYPE:
850
ADDRESS:1170 YORKSHIRE DRIVETELEPHONE:
(408) 359-7151
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 37DATE:
10/23/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Sara Spiegel & Caroline GuptaTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico met with Licensee Representative, Sara Spiegel, and Director of Facilities and Operations, Caroline Gupta, for an unannounced follow up Case Management inspection regarding an incident that was reported to Licensing on October 9, 2025, involving a three-year-old day-care child (C1) who sustained an injury at the center. LPA toured the facility and a census was taken.

During the investigation process, LPA conducted observations, interviewed staff, reviewed records, and obtained pertinent documents. Based on the information gathered, on October 8, 2025, a child (C1) was running with other children on a concrete path in the playground holding a jar. C1 fell on top of the jar, causing the jar to break, and resulted in a deep cut to the child's abdominal area. There were two staff members (S1 & S2) with approximately 20 children present in the playground when the injury occurred. S1 rushed to C1, provided first aid, and instructed a fellow staff to contact 911. Staff called 911 and the child's parents were immediately notified. Emergency personnel arrived at the center and transported the child to the hospital. Licensee Representative stated that the child had undergone surgeries. Licensee Representative stated that as of today, October 23, 2025, C1 still in the hospital.

After the incident, staff removed all glass materials from the classrooms, weekly all-team meetings have been established to review safety protocols, and additional staff will be placed indoor and outdoor to cover ratios.

Per California Code of Regulations Title 22, Chapter 1, the following deficiency is cited: (see LIC 809D)

Continuation on next page:
NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Marilou Monico
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2025
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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Document Has Been Signed on 10/23/2025 03:34 PM - It Cannot Be Edited


Created By: Marilou Monico On 10/23/2025 at 02:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: TESSELLATIONS CHILDREN'S CENTER
FACILITY NUMBER: 434417135

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
101223(a)(2)

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Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Licensee Representative states that she will submit a detailed plan by 10/24/25 on how staff will maintain safe environment to children and how staff will ensure that adequate supervision is provided to children at all times.
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This requirement was not met as evidenced by: On 10/08/25, staff did not maintain a safe environment to children due to lack of supervision which resulted in serious bodily injury to a child (C1) in care. This posed an immediate risk to the health, safety and personal rights of children in care.
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Since this violation resulted in a serious injury of a child, a civil penalty of $5,000 is hereby assessed.

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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.
Deanna Villagrana
NAME OF LICENSING PROGRAM MANAGER:
Marilou Monico
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2025


LIC809 (FAS) - (06/04)
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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: TESSELLATIONS CHILDREN'S CENTER
FACILITY NUMBER: 434417135
VISIT DATE: 10/23/2025
NARRATIVE
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Assembly Bill (AB) 633 was provided and discussed with Licensee Representative.

LPA informed the Licensee Representative, Sara Spiegel, that this report dated October 23, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Monico informed the Licensee Representative to provide a copy of this licensing report dated October 23, 2025 that documents any Type A citation to parents/guardians of all children currently enrolled no later than the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224),or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Licensee Representative, Sara Spiegel. Copy of appeal rights was provided.

A Notice of Site Visit was issued and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Marilou Monico
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC809 (FAS) - (06/04)
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