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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444413558
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:45:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2024 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240708122931
FACILITY NAME:GIVING TREE ACADEMYFACILITY NUMBER:
444413558
ADMINISTRATOR:SOSA, JENNIFERFACILITY TYPE:
850
ADDRESS:175 LAWRENCE AVENUETELEPHONE:
(831) 254-0983
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:90CENSUS: DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jenifer SosaTIME COMPLETED:
02:54 PM
ALLEGATION(S):
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Staff do not maintain a safe playground
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Cortney Nelson and Jennifer "Jen" Beehler, met with Site Director, Jenifer Sosa, and explained purpose of visit to open a 10 day complaint investigation. Upon arrival, LPAs were admitted into the facility by a staff member. Jenifer Sosa, Director of facility, arrived approximately 30 minutes later.

During today's inspection, LPAs toured the outside play yard and observed the yard to have dry grass and numerous holes were observed. Some holes were filled and the grass was cut following the plan of correction from the Annual visit on 6/7/24. The grass was dry and brittle. LPA's walked the parameter of the play area and observed the wood barrier to be solid and secure. There were three rusty nails that were protruding that could cause a safety risk. The cement area had a large crack and there was raised cement on the back side of one of the trees. The raised concrete poses a tripping hazard and had some exposed jagged edges that could be a potential risk to children at play.

**Continues on LIC9099C**
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20240708122931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558
VISIT DATE: 07/09/2024
NARRATIVE
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Based on the available evidence, the preponderance of evidence standard has been met and therefore the above allegation is SUBSTANTIATED.

As a result of today's inspection, a deficiency was cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Site Director, Jenifer Sosa.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20240708122931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
CCR
101238.2(d)(2)
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101238.2 Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including... holes...and dry grasses that pose a fire hazard.

This requirement was not met as evidenced by:
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Site Director states she will meet with the Pastor and the Board to discuss the remediation of the grass area and cement cracking. Plan should be submitted to the Department by 7/12/2024.
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The site director did not maintain the outdoor activity space as there were holes, dry grass, cracked cement and protruding rusty nails which poses a potential risk to the health, safety and personal rights of children in care.
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Everything will be addressed and corrected by 7/26/2024. A follow up plan of correction visit will be conducted to observe the repairs to the outdoor actiivty space.
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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 SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3