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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
430710384
Report Date:
03/12/2020
Date Signed:
03/13/2020 09:14:21 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:
CALVARY CHAPEL CHRISTIAN SCHOOL
FACILITY NUMBER:
430710384
ADMINISTRATOR:
MELINDA TIOPAN
FACILITY TYPE:
850
ADDRESS:
1175 HILLSDALE AVENUE
TELEPHONE:
(408) 269-2222
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95118
CAPACITY:
90
CENSUS:
18
DATE:
03/12/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:15 PM
MET WITH:
Tiopan Melinda
TIME COMPLETED:
01:25 PM
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A case management visit was made by Analyst Behbood to follow up on the citations issued during annual visit on 02/05/20.
Tiopan provided copies of all the proof of corrections emailed to analyst on 02/07/20 which was not received.
Copies of the corrections received and reviewed. Two playgrounds inspected for tan barks. Both playground now have plenty of tan barks.
All citations are now corrected.
No additional citation issued.
SUPERVISOR'S NAME:
Anthony Studebaker
TELEPHONE:
(408) 324-2155
LICENSING EVALUATOR NAME:
Mahvash Behbood
TELEPHONE:
(408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE:
03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/12/2020
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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