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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710492
Report Date: 10/06/2023
Date Signed: 10/06/2023 10:44:46 AM

Document Has Been Signed on 10/06/2023 10:44 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430710492
ADMINISTRATOR:STRANGE, BRITTANYFACILITY TYPE:
830
ADDRESS:3030 MOORPARK AVENUETELEPHONE:
(408) 249-0668
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 97TOTAL ENROLLED CHILDREN: 84CENSUS: 51DATE:
10/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brittany Strange & Shivangi MehtaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management Inspection. The facility was cited on 09/13/23 under Buildings and Grounds. LPA met with Site Director, Brittany Strange, and Assistant Director, Shivangi Mehta. LPA toured the facility, interviewed staff, and obtained copy of services agreement from Orkin Pest Control.

As a result of this inspection the deficiency under Buildings and Grounds is hereby corrected and cleared.

There were no deficiencies cited.

Exit interview conducted and report was reviewed with Site Director, Brittany Strange, and Assistant Director, Shivangi Mehta.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
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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