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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444412727
Report Date: 12/10/2025
Date Signed: 12/10/2025 04:41:43 PM

Document Has Been Signed on 12/10/2025 04:41 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:CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.FACILITY NUMBER:
444412727
ADMINISTRATOR/
DIRECTOR:		LOPEZ, PATRICIAFACILITY TYPE:
850
ADDRESS:4510 JADE STREETTELEPHONE:
(831) 475-5188
CITY:CAPITOLASTATE: CAZIP CODE:
95010
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 27DATE:
12/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Patricia LopezTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On December 10, 2025, Licensing Program Analyst (LPA) Syeda Bahar conducted an unannounced case management inspection at the facility and met with Director Patricia Lopez. The purpose of the visit was to follow up on an unusual incident reported to the San Jose Community Care Licensing Office on December 3, 2025. The incident involved one child (C1) and one staff member (S1). During the inspection, LPA toured both the indoor and outdoor areas of the facility. A census was taken during the visit.

According to the incident report, on December 2, 2025, at approximately 12:30 PM, Child (C1) was found unsupervised in the outdoor play yard. During the transition from outdoor to indoor activities, Staff-S1 had returned to the classroom with her group of children around 12:20 PM. Upon entering the classroom, Staff-S1 noticed that C1 was missing. Staff-S1 immediately went outside and found C1 inside the playhouse. It was reported that C1 was alone outside for approximately 5–10 minutes. The child (C1) was not harmed, injured, or visibly upset. At the time of the incident, there were four staff members and twelve children present.

Based on staff interviews, it was confirmed that teachers typically give children a 5-minute warning before transitioning indoors. Children then line up near the fence, and a headcount is conducted before entering the classroom. During the incident there were 11 children and 2 staff were outside. 2 staff and 1 child were inside the classroom. A parent was present, picking up a child during the transition. Staff-S1 admitted that she did not conduct a headcount before bringing the group inside. Staff-S1 returned to the classroom with 10 children, as 1 child was being picked up by the parent. Staff-S1 stated she had seen C1 standing next to the parent holding a water bottle.

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NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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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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: CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.
FACILITY NUMBER: 444412727
VISIT DATE: 12/10/2025
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[Page 2]
Once inside, Staff-S1 took two children to the bathroom for diaper changes. Staff-S2 was setting up nap equipment. The classroom lights were off. When all children were on their cots for nap time, Staff-S1 realized C1 was missing. Staff-S1 went outside and found the child (C1) in the playhouse. C1 was brought back inside and went to sleep.

Director Patricia Lopez acknowledged that the incident occurred due to lack of supervision, resulting in the child being left outside unattended. As a corrective action, the Director held a follow-up meeting with Staff S1. Director reviewed the outdoor area for safety improvements, including relocating the playhouse to improve visibility and supervision.

Director was advised to provide extended training to all staff on maintaining visual supervision at all times, ensuring that no child is left unattended. A designated pickup and drop-off area and responsible staff should be established, along with a scheduled pickup time for parents to support smoother transitions. Additionally, any objects that may obstruct staff’s line of sight should be removed or repositioned to maintain clear visibility of all children.

Based on the information gathered, it was determined that the incident occurred due to lack of supervision. Per the California Code of Regulations Title 22, Division 12, Chapter 1, one "Type -A" deficiency is cited on the attached LIC 809-D form.

Deficiency Cited: Responsibility for Providing Care and Supervision - CCR 101229(a)(1)
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.

LPA discussed the requirements of AB633 with the Director, Patricia Lopez and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). Director stated that she understands the requirements. Please refer to page 809-D for citation, description, and plan of correction. Exit interview conducted and report was reviewed with the Director, Patricia Lopez. Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2025 04:41 PM - It Cannot Be Edited


Created By: Syeda Bahar On 12/10/2025 at 04:14 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: CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.
FACILITY NUMBER: 444412727

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2025
Section Cited
CCR
101229(a)(1)

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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...Supervision shall include visual observation.
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By the Plan of Correction (POC) due date of 12/11/2025, the Director will submit a written plan detailing staff training on supervision, activity transitions, indoor and outdoor staff positioning, and child sign-in/sign-out procedures. Director will contact the LPA to confirm the training date.
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This requirement was not met as evidenced by: On 12/2/2025, Child #1 (C1) was found unsupervised in the outdoor playhouse for approximately 5–10 minutes. Staff S1 did not conduct a headcount during the transition from outdoor to indoor activities, resulting in C1 being left outside unattended.
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Upon completion, the Director will submit the training agenda, materials, and staff attendance sheet to the Department for review.

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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.
Mireya Flores
NAME OF LICENSING PROGRAM MANAGER:
Syeda Bahar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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