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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710441
Report Date: 04/16/2024
Date Signed: 04/16/2024 10:39:33 AM


Document Has Been Signed on 04/16/2024 10:39 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:ROULEAU HEAD STARTFACILITY NUMBER:
430710441
ADMINISTRATOR:CUC TRANFACILITY TYPE:
850
ADDRESS:1875 MONROVIA DRIVETELEPHONE:
(408) 573-4717
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:105CENSUS: 48DATE:
04/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cuc TranTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management investigation regarding an improper practice of staff interacting with a child which was reported to the department. LPA met with site director, Cuc Tran and discussed the case management with her. LPA also toured the classroom of the Facility, reviewed children & staff files, and interviewed staffs and a child during today's investigation.

Further investigation is required and the investigation is thus CONTINUING.

Notice of site visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
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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