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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710492
Report Date: 04/06/2022
Date Signed: 04/06/2022 09:32:25 AM


Document Has Been Signed on 04/06/2022 09:32 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:97CENSUS: 45DATE:
04/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Brittany Strange & Madison GatesTIME COMPLETED:
09:45 AM
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 Licensing Program Analyst (LPA) Marilou Monico conducted a Plan of Correction inspection. On March 23, 2022, the facility was cited under Staff-Infant Ratio. LPA met with Site Director, Brittany Strange, and Administrative Staff, Madison Gates, and explained the purpose of today's inspection.

LPA toured the facility. LPA observed the following:
Room 1 - 3 teachers and 10 infants
Room 2 - vacant
Room 3 - 2 teachers, 2 teacher aides, and 7 infants
Room 4 - 2 teachers and 6 infants
Room 5 - 2 teachers and 6 infants
Room 6 - 2 teachers and 5 infants
Room 7 - 2 teachers, 1 teacher aide, and 11 infants

LPA observed completed and signed Acknowledgement of Receipt of Licensing Report (LIC 9224) forms.

Deficiency under Staff-Infant Ratio is hereby corrected and cleared.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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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