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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703695
Report Date: 10/20/2021
Date Signed: 10/20/2021 09:17:40 AM

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:SJB - SAN JUAN BAUTISTA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703695
ADMINISTRATOR:ANN-MARIE LEMMERMANFACILITY TYPE:
850
ADDRESS:1945 TERILYN AVENUETELEPHONE:
(408) 259-4796
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:231CENSUS: 57DATE:
10/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Annie LemmermanTIME COMPLETED:
09:30 AM
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Licensing Program Analysts (LPAs) Janette Cruz and Mel Matos met with Annie Lemmerman, Director, to conduct an unannounced follow-up case management inspection. Purpose of today's inspection: deliver an amended report dated 10/15/21 regarding the Facility’s request for a change of capacity.

LPAs added the measurement of toddler classroom 1A on the amended report.

An exit interview was conducted with Director, Annie Lemmerman. No other deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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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