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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710492
Report Date: 08/28/2019
Date Signed: 08/28/2019 09:22:36 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:ACTION DAY NURSERYFACILITY NUMBER:
430710492
ADMINISTRATOR:KARLA TUREISKYFACILITY TYPE:
830
ADDRESS:3030 MOORPARK AVENUETELEPHONE:
(408) 249-0668
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:97CENSUS: 72DATE:
08/28/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 PM
MET WITH:Samantha SilvaTIME COMPLETED:
09:30 PM
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LPA conducted a Case Management inspection to the facility today to deliver an Amended Report dated 08/22/19 and to discuss Safe Sleep practices. LPA met with and Center Director, Samantha Silva, and reviewed the Amended report. LPA discussed Safe Sleep practices and provided information.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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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