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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274400043
Report Date:
02/01/2023
Date Signed:
02/01/2023 01:41:41 PM
Document Has Been Signed on
02/01/2023 01:41 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
CCLD Regional Office
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
PRUNEDALE CHRISTIAN PRE-SCHOOL
FACILITY NUMBER:
274400043
ADMINISTRATOR:
BETTY E. MOON
FACILITY TYPE:
850
ADDRESS:
8145 PRUNEDALE NORTH ROAD
TELEPHONE:
(831) 663-2211
CITY:
PRUNEDALE
STATE:
CA
ZIP CODE:
93907
CAPACITY:
45
CENSUS:
0
DATE:
02/01/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:25 PM
MET WITH:
Michael Moon
TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced Case Management visit to confirm if preschool was operating. LPA met with Teacher Michael Moon and explained the nature of today's visit. Michael inform LPA preschool has been close since March 2020 and is currently not operating. LPA did not observe any children in care. Michael stated preschool would like to remain open and be granted a inactive status due to plans of renovation to the preschool. LPA provided the request for inactive child care license status form. LPA also provided a copy of annual fees due.
Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Elizabeth Larios
TELEPHONE:
(408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE:
02/01/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/01/2023
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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