<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417232
Report Date: 07/01/2026
Date Signed: 07/01/2026 02:31:27 PM

Document Has Been Signed on 07/01/2026 02:31 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:ACTION DAY SCHOOLSFACILITY NUMBER:
434417232
ADMINISTRATOR/
DIRECTOR:		ALYSSA CONTRERASFACILITY TYPE:
860
ADDRESS:1125 WEST CAMPBELL AVENUETELEPHONE:
(408) 244-1968
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 406TOTAL ENROLLED CHILDREN: 250CENSUS: 163DATE:
07/01/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH: Alyssa ContrerasTIME VISIT/
INSPECTION COMPLETED:
02:46 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 07/01/2026, Licensing Program Analyst (LPA), Syeda Bahar conducted an unannounced Case Management - Deficiencies investigation at the facility. LPA met with the Director, Alyssa Contreras explained the purpose of today's visit. During today’s inspection, LPA toured the indoor and outdoor areas of the facility and a census was taken.

During the infant classroom tour, LPA observed the changing tables in the infant classrooms were not placed within arm’s reach of a sink. Director was advised that, per Title 22 regulations, Infant changing tables shall be placed within arm's reach of a sink while in use.

During the outdoor tour, LPA observed that there were multiple uneven (broken) concrete surfaces, presenting tripping hazard. Director was advised that per Title 22 regulations, the surface of the outdoor activity space shall be maintained in a safe condition for the activities planned. The outdoor play area must be free of hazards including, but not limited to, holes, broken glass and other debris, and dry grass that pose a fire hazard. Director stated that a work order for the repair of the outdoor concrete surface is currently in place. However, the work order completion date is undetermined.

Based on the observations and interviews two type B deficiencies were cited on the attached page 809-D. Appeal rights were provided.

Exit interview was conducted, and the report was reviewed with the Director, Alyssa Contreras. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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)
Page: 2 of 3
Document Has Been Signed on 07/01/2026 02:31 PM - It Cannot Be Edited


Created By: Syeda Bahar On 07/01/2026 at 01:48 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: ACTION DAY SCHOOLS
FACILITY NUMBER: 434417232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2026
Section Cited
CCR
101439(h)(4)

1
2
3
4
5
6
7
Infant Care Center Fixtures, Furniture, Equipment and Supplies: (h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
By the plan of correction (POC) due date 07/31/26, Director will submit pictures of the changing tables in each inafant classrooms, demonstrating the corrected layout, showing that the changing tables are positioned within arm's reach of a sink.
8
9
10
11
12
13
14
Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The changing tables in the infant classrooms (12, 14) were not placed within arm’s reach of a sink.
8
9
10
11
12
13
14
Type B
07/31/2026
Section Cited
CCR101238.2(d)(2)

1
2
3
4
5
6
7
Outdoor Activity Space: (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
By the plan of correction (POC) due date 07/31/26, Director will submit pictures of the outdoor playground surfaces, showing that the work order is compete and the uneven (broken) surfaces have been repaired.
8
9
10
11
12
13
14
Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. There were multiple uneven (broken) concrete surfaces on the playground, presenting tripping hazard.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mireya Flores
NAME OF LICENSING PROGRAM MANAGER:
Syeda Bahar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 3 of 3