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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400069
Report Date: 10/24/2019
Date Signed: 10/24/2019 04:34:49 PM

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:SCHOLARS ACADEMYFACILITY NUMBER:
434400069
ADMINISTRATOR:ARSHIA ALIFACILITY TYPE:
850
ADDRESS:3703 SILVER CREEK ROADTELEPHONE:
(408) 238-2500
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:167CENSUS: 28DATE:
10/24/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Arshia AliTIME COMPLETED:
05:00 PM
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On 10/24/19 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Plan of Correction Inspection (POC) at Scholars Academy. LPA met with Director, Arshia Ali and explained the purpose of today's inspection.

On 10/09/19 during an unannounced annual/random inspection, facility was issued citation for:
101238 (a) Building & Grounds - damaged, unsafe covers and wood frame around water sprinkler system equipment in the outdoor playground. During today's POC inspection, LPA noted the cover and wood frame was locked, freshly painted and unsafe parts were corrected. Citation was cleared and a Letter of Clearance was provided to the Director.

No deficiency was cited today. This report was reviewed with the Director.
A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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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