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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597488
Report Date: 10/14/2026
Date Signed: 10/14/2026 10:43:33 AM

Document Has Been Signed on 10/14/2026 10:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SAN JOSE/CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191597488
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
850
ADDRESS:2015 CADILLAC DRIVETELEPHONE:
(909) 397-4673
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 23TOTAL ENROLLED CHILDREN: 1223CENSUS: 12DATE:
10/14/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Alma Giatian Nurse/TIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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) Kamile Martin (K Martin) conducted an unannounced Case Management Inspection due to a UIR (Unusual Incident report) reported to the Monterey Park Regional Office on 10/12/26 by FSA Family Service Advocate Yvette Corral. LPA K Martin observed 12 children in care and 2 staff in the facility. The facility was observed to be operating within the license capacity limitations. Sign in sheet was reviewed upon inspection. LPA met with Program Assistant Michelle Smith and Nurse Alma Gaitan. This program is located at San Jose Elementary School Campus Room P21.

On 10/14/26 LPA K Martin conducted a visit to the facility mentioned above to follow up on the UIR which states Child has contacted E.coli virus at home she has experienced vomiting, diarrhea, and fever symptoms and parent took the child to the hospital, where she was later diagnosed with diagnosed the E. coli bacteria infection. Per Nurse she states parents took the child to the hospital at 4 am in the morning on 10/6/26, where she was diagnosed with E.Coli. bacteria . Per Nurse Alma, she states that parents did not have any changes within their routine or foods served in the home and no one else in the home got sick. Nurse spoke with parent on 10/9/26 and parent states child was discharged from the hospital and child is discharged with oral antibiotics and received a note to return to school on 10/15/26.On 10/13/6 The public health nurse contacted nurse Alma and she informed her that the child was cleared on her end to return to school and Alma confirmed with the mother and mother provided a doctor clearance to return 10/15 /26 without restrictions. LPA interviewed Teacher Victoria Chavez. Per teacher child follows routine, is happy and attends the program regularly. LPA will follow up with the nurse to ensure child is back to normal routine.

Based on information obtained during the investigation, Policies and procedures that were followed, further follow up is not

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00

Exit interview conducted and report was reviewed with Nurse Alma Gaitian

Christina Gabelman
Kamile Martin
DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2026
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
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)
Page: 2 of 2