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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444400117
Report Date: 03/18/2024
Date Signed: 03/18/2024 01:36:31 PM


Document Has Been Signed on 03/18/2024 01:36 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:ROCKING HORSE RANCH PRESCHOOLFACILITY NUMBER:
444400117
ADMINISTRATOR:NANCY COHENFACILITY TYPE:
850
ADDRESS:4134 FAIRWAY DR.TELEPHONE:
(831) 462-2702
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:30CENSUS: 28DATE:
03/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Megan BaroniTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst(LPA) Jessica Bongardt met with Margaret "Megan" Belssing-Baroni, Site Director for a Case Management visit. LPA was at the facility for another issue, while going through staff files it was discovered that S1 did not have current Mandated Reporter Training on file.

This item causes a health and safety risk to the children in care. A Type B citation will be issued for this deficiency.

Notice of site visit will be issued and must be posted for 30 days.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024
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 2


Document Has Been Signed on 03/18/2024 01:36 PM - It Cannot Be Edited

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: ROCKING HORSE RANCH PRESCHOOL
FACILITY NUMBER: 444400117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
HSC
1596.8662(b)(3)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
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S1 will complete the Mandated Reporter Traning on or before the plan of correction date and submit it to the department.
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Based on observation, interview, record review, the Site Director did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons 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: Gladys KuizonTELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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