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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413558
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:43:17 PM

Document Has Been Signed on 12/11/2024 03:43 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:GIVING TREE ACADEMYFACILITY NUMBER:
444413558
ADMINISTRATOR/
DIRECTOR:		SOSA, JENNIFERFACILITY TYPE:
850
ADDRESS:175 LAWRENCE AVENUETELEPHONE:
(831) 254-0983
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 90TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Jennifer SosaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Darnella Barnes met with Site Director Jennifer Sosa in a case management inspection.
Site Director was informed that the facility has an outstanding balance as of today of $1064.00 Site Director understands that failing to pay licensing fees constitute grounds for forfeiture her license.
Site Director was unable to provide LPAs with a current children's roster.

Two type B deficiencies were cited today.

Failure to comply with the Plan Of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day per each deficiency.

A notice of site visit was given and must remain posted for 30 days

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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 12/11/2024 03:43 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 12/11/2024 at 03:10 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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2024
Section Cited
HSC
1596.803(e)

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(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license.

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Site Director was informed that she has until December 26, 2024 to pay the outstanding balance as of today $1064.00 Ms. Sosa understands that not paying the outstanding balance constitutes grounds for forfeiture the license.
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LIS report dated 12/10/24 shows an outstanding balance of $1064.00
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Type B
12/26/2024
Section Cited
HSC1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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Site Director will produce a current roster for all the children enrolled and will submit a copy to licensing Department no later than 12/26/26.
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This roster shall be available to the licensing agency upon request.
This requirement was not met as evidenced by Site Director was unable to produce a children's roster, this poses a potential risk health, safety, personal rights risk to children 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:Susy Cervantes
LICENSING EVALUATOR NAME:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
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