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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700096
Report Date: 05/20/2019
Date Signed: 05/20/2019 12:14:37 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:DISCOVERY PARENT CHILD PRESCHOOLFACILITY NUMBER:
430700096
ADMINISTRATOR:SALLY STARZFACILITY TYPE:
850
ADDRESS:1919 GUNSTON WAYTELEPHONE:
(408) 377-5390
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:28CENSUS: DATE:
05/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Sally StarzTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Stephanie Rangel made a case management inspection to the facility in order to receive an updated Unusual Incident/Injury report (LIC 624) that was submitted to CCL on 4/8/19. LPA met with Sally Starz, director and explained the nature of today's inspection. LPA had previously called the facility on 4/10/19 and 5/16/19 in order ask facility to submit a revised incident report on the correct form. Report was not resubmitted.

LPA learned from director that parent helpers check the phone line of 408-377-5390 and she did not receive the messages from LPA. LPA reminded facility to ensure that the parent helpers understand the need to receive voice mails and to check online for all updated forms for submission to CCL.

LPA received a revised report during today's inspection.

No deficiencies have been cited.

Notice of site visit was issued and shall remain posted for 30 days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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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