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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710379
Report Date: 10/02/2024
Date Signed: 10/02/2024 10:43:51 AM

Document Has Been Signed on 10/02/2024 10:43 AM - 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:LIVE OAK PRESCHOOLFACILITY NUMBER:
440710379
ADMINISTRATOR/
DIRECTOR:		MAGDALENA GONZALEZFACILITY TYPE:
850
ADDRESS:1916 CAPITOLA ROADTELEPHONE:
8314621116
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 44TOTAL ENROLLED CHILDREN: 32CENSUS: 26DATE:
10/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Donna GeffkenTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Mel Matos and Andy Yang met with Donna Geffken, director, for an unannounced case management investigation in response to an Unusual Incident that the Facility reported to the Department on September 19, 2024. LPAs also toured the playground area and interviewed staff during today's investigation.

The Unusual Incident occurred on September 18, 2024 at approximately 11:30 AM in the preschool playground. Donna states that the child was left in the preschool playground when Room 1 (A) transitioned back to the classroom. Donna states that a preschool child from Room 1 (A) was found outside in the preschool playground by another staff from Room 2 (B). Donna states that the preschool child was found waiting directly outside Room 1 (A) and brought back inside the Room. Donna states that the child was left outside when Room 1 (A) transitioned back to the classroom approximately five minutes prior. Donna states that there were 12 preschool children with two staff outdoors when Room 1 (A) transitioned back indoors. The preschool playground is fenced and each Room has a back door which leads to the preschool playground. Donna states that the child was fine and was not upset.

Donna states that she spoke with the staff about the incident and also notified the child's parents via telephone. Donna states that the child is still enrolled at the Facility and is doing fine.

Donna states that she has spoken with staff from both classrooms after the incident and reminded them of the supervision requirements for transition periods (coming and going) during outdoor times.

Based on the available evidence, it is concluded that a child was left outside in the preschool playground on September 18, 2024 when Room 1 (A) transitioned back to the classroom. This presents a potential health & safety risk and thus a "Type B" deficiency is cited on the attached page (809-D). Exit interview conducted and report was reviewed with the Director, Donna Geffken, and copy of appeal rights was provided. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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Document Has Been Signed on 10/02/2024 10:43 AM - It Cannot Be Edited


Created By: Melvin S Matos On 10/02/2024 at 10:15 AM
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: LIVE OAK PRESCHOOL
FACILITY NUMBER: 440710379

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Donna Geffken, Director, agreed to submit a written Plan of Correction to LPA Matos by Friday October 11, 2024 indicating additional procedure(s) that have been/will be implemented to ensure that children are supervised at all times, including during transition times to and from the preschool playground.
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This requirement was not met as evidenced by: a child was left in the preschool playground when Room 1 (A) transitioned back to the classroom on 09/18/24. The child was brought inside by staff approximately 5 minutes later. This presents a potential risk to the health, safety or personal rights of 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.
SUPERVISOR'S NAME:Belinda Devall
LICENSING EVALUATOR NAME:Melvin S Matos
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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