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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444412727
Report Date: 02/04/2025
Date Signed: 02/04/2025 03:45:30 PM

Document Has Been Signed on 02/04/2025 03:45 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: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: 30DATE:
02/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:44 PM
MET WITH:Patricia Lopez & Janet CannonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted unannounced Case Management inspection and met with Site Director Patricia "Patty" Lopez. Purpose of today's inspection discuss an unusual incident report that Preschool Program Supervisor, Janet Cannon self reported to the Department on January 31, 2025.

LPA obtained copies of pertinent information and conducted interviews during today's inspection.
On 1/30/2025 staff (S-1) was observed by staff (S-2) leaving a child unsupervised outside the door that leads to the playground. Staff (S-1) and the other children entered the classroom and the door was closed, leaving child (C-1) unsupervised outside. Staff (S-2) immediately told staff (S-1) that child (C-1) was outside and redirected child back inside classroom.

The following "Type A" deficiency was cited and is noted on the attached page (LIC 809-D)

LPA discussed the requirements of AB633 to Janet Cannon and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and understands the requirements. LPA conducted an exit interview with the Janet Cannon, Preschool Program Supervisor where this report was reviewed and copy of appeal rights was provided. Please refer to page 809-D for citation, description, and plan of correction.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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Document Has Been Signed on 02/04/2025 03:45 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 02/04/2025 at 02:47 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: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2025
Section Cited
CCR
101229(a)(1)

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101229 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.
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Director agreed to submit a written Plan of Correction (POC) to LPA indicating what steps will be implemented to ensure that the day care children are supervised at all times and conducted staff training, by POC due date.
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This requirement was not met as evidenced by: On 1/30/2025 staff (S-1) was observed by staff (S-2) leaving a child unsupervised outside the door that leads to the playground. Staff (S-1) and the other children entered the classroom and the door was closed, leaving child (C-1) unspervised outside. Staff (S-2) immediately told staff (S-1) that child (C-1) was outside and redirected child back inside classroom. This poses an immediate threat to the health and safety of children in care.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file.

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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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025


LIC809 (FAS) - (06/04)
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