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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 350700523
Report Date: 07/25/2019
Date Signed: 07/25/2019 04:37:19 PM

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:PRESBYTERIAN CO-OPERATIVE PRESCHOOLFACILITY NUMBER:
350700523
ADMINISTRATOR:WENDY SUE CLARK SHEPHERDFACILITY TYPE:
850
ADDRESS:2066 SAN BENITO STREETTELEPHONE:
(831) 630-1234
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:60CENSUS: 0DATE:
07/25/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Wendy Shepherd & Kelly HackerTIME COMPLETED:
04:45 PM
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LPM Mary Segura and LPA Janet Tse met with director Wendy Shepherd and teacher Kelly Hacker at the San Jose Regional Office for a meeting to discuss the status of the corporation with the Secretary of State. The First Presbyterian Church of Hollister, C0141131 was placed on suspension as of 05/29/2019 for failure to file a timely statement of information form (SI-100) with the Secretary of State of California. As the corporation is the Licensee, it must have an active corporation status in order for the license to be valid. Ms. Shepherd reports that the center is closed for the summer and no children are provided care and supervision at this time. The Facility is advised that they must complete whatever requirements that the Secretary of State for the state of California deems necessary to return the corporation to an active status within the next 30 days. If after that point in time, the corporation has not been reinstated to an active status, the center license will be forfeited. Ms. Shepherd also understands that they must not accept children into care until such time that the corporation status has been restored to a fully active status. Ms. Shepherd will also notify the Department when the corporation has been restored to an active status.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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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