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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408785
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:44:53 PM

Document Has Been Signed on 10/16/2024 04:44 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CKC CHILDREN'S CENTERFACILITY NUMBER:
444408785
ADMINISTRATOR/
DIRECTOR:		NIDYA JUAREZFACILITY TYPE:
850
ADDRESS:8005 WINKLE AVENUETELEPHONE:
(831) 475-6587
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 14DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:41 PM
MET WITH:Tina Burcher & Drew SaldivarTIME VISIT/
INSPECTION COMPLETED:
04:55 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
Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management inspection in response to an incident that was self-reported by the facility on October 10, 2024 and to obtain signature for an amended report. LPA toured the facility both indoor and outdoor and interviewed staff. LPA met with Preschool Site Director, Tina Burcher, and School Age Program Director, Drew Saldivar. Tina left during the inspection.

LPA learned that on October 9, 2024, a daycare child, C1, exited the playground unnoticed by staff and had gone out the gate. Staff were searching for the child until they heard from the intercom of the school that a toddler was by the picnic table on the school campus. The picnic table is located outside the gate/fence area of the playground. C1 was retrieved by staff and was brought to the facility.

As a result of this inspection, Type A deficiency was cited on the following page.

Assembly Bill (AB) 633 was provided and discussed with the School Age Program Director, Drew Saldivar. LPA informed Drew to provide a copy of this licensing report dated October 16, 2024 that documents a 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 parents/guardians of any newly enrolled children for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224) must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with School Age Program Director, Drew Saldivar.

A Notice of Site Visit was issued and must remain posted for 30 days.



SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 10/16/2024 04:44 PM - It Cannot Be Edited


Created By: Marilou Monico On 10/16/2024 at 04:09 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: CKC CHILDREN'S CENTER
FACILITY NUMBER: 444408785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2024
Section Cited
HSC
101229(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision - (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) 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.
1
2
3
4
5
6
7
By POC due date: 10/17/24, the facility to submit a detailed plan on how staff will maintain adequate supervision of children at all times. An All Staff Training regarding active supervision and safety protocols to be conducted. Training agenda and staff attendance to be sent to Licensing by 10/25/24.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: A daycare child, C1, exited the playground unnoticed by staff and had gone out the gate. This poses an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
Because the facility has been cited for repeating the same violation within 12 months, an immediate civil penalty of $1000 was assessed. Civil penalty of $100 per pay continues until the violation is corrected.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2