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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710433
Report Date: 12/06/2022
Date Signed: 12/08/2022 04:59:44 PM


Document Has Been Signed on 12/08/2022 04:59 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:BOWERS STATE/DISTRICT PRESCHOOLFACILITY NUMBER:
430710433
ADMINISTRATOR:ROSIE FLORESFACILITY TYPE:
850
ADDRESS:2755 BARKLEY AVENUETELEPHONE:
(408) 423-1117
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:87CENSUS: 9DATE:
12/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Francis O'BienTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management visit and was greeted by Teacher, Mrs. Frances O'Brien

On 12/2/22, LPA Morales had conducted a Case Management visit in response to an Incident that occurred on 11/9/22. Upon further investigation, it was determined that the teacher who was involved with the incident is from the INCLUSION PROGRAM and not from the PRESCHOOL PROGRAM.

No further investigation needed nor a citation was given.

Exit interview was conducted with Mrs. O'Brien.

NOTICE OF SITE VISIT WAS ISSUED. LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE PRESCHOOL FOR A PERIOD OF 30 DAYS.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022
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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