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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710433
Report Date: 09/20/2024
Date Signed: 09/23/2024 09:38:32 AM

Document Has Been Signed on 09/23/2024 09:38 AM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BOWERS STATE/DISTRICT PRESCHOOLFACILITY NUMBER:
430710433
ADMINISTRATOR/
DIRECTOR:		DAISY CANOFACILITY TYPE:
850
ADDRESS:2755 BARKLEY AVENUETELEPHONE:
(408) 423-1117
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 87TOTAL ENROLLED CHILDREN: 87CENSUS: 7DATE:
09/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Frances O'BrienTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analysts(LPA's) Anna Morales and Shine Yu conducted an Unannounced Case Management Inspection in response to an Unusual Incident that was self reported by the facility to Licensing on September 12, 2024. LPA's were greeted by Lead Teacher Frances O'Brien.

Lead Teacher stated stated that an Incident occurred on 9/12/24. She stated there were
12 children and three staff present. Upon further investigation, it was determined that one of the 12 children who was involved with this 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 Frances 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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