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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710319
Report Date: 03/23/2023
Date Signed: 03/23/2023 05:38:15 PM


Document Has Been Signed on 03/23/2023 05:38 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CARTER AVENUE CHRISTIAN PRESCHOOL AND DAYCAREFACILITY NUMBER:
430710319
ADMINISTRATOR:RACHEL SAYREFACILITY TYPE:
840
ADDRESS:5303 CARTER AVENUETELEPHONE:
(408) 265-3580
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:42CENSUS: 14DATE:
03/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rachel SayreTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kassandra Medrano conducted a random case management inspection today. LPA met with Rachel Sayre, Director. The purpose of the visit was explained, to discuss an incident reported in September 9,2022. The incident was investigated community care licensing investigation and no action is being taken at this time as it was determined to be unsubstantiated.


Exit interview was conducted with Director, Rachel Sayre. No deficiencies cited.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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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