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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709448
Report Date: 10/22/2024
Date Signed: 10/22/2024 03:12:10 PM

Document Has Been Signed on 10/22/2024 03:12 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:PRIMARY PLUS - INFANTSFACILITY NUMBER:
430709448
ADMINISTRATOR/
DIRECTOR:		LOPEZ, LORENAFACILITY TYPE:
830
ADDRESS:18720 BUCKNALL ROADTELEPHONE:
(408) 370-0350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 43DATE:
10/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:01 PM
MET WITH:Lorena LopezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Director Lorena Lopez and explained the reason for the inspection. The purpose of this inspection is to discuss the infant sleeping equipment.

During today's inspection, LPA observed that there was a binder ring that had a tag with the child's name attached to the side of the crib. Staff removed tag during today's inspection.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Director Lorena Lopez. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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