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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407992
Report Date: 05/30/2019
Date Signed: 05/30/2019 04:27:20 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:NEIGHBORHOOD CHRISTIAN CENTERFACILITY NUMBER:
434407992
ADMINISTRATOR:MARQUES-HAHN, G.FACILITY TYPE:
850
ADDRESS:887 POMEROY AVENUETELEPHONE:
(408) 984-3418
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:155CENSUS: 0DATE:
05/30/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Graciela Marques-HahnTIME COMPLETED:
04:30 PM
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On 05/30/19 Licensing Program Analyst conducted an unannounced Case Management - Incident Investigation at Neighborhood Christian Center, met with Director, Graciela Marques-Hahn and explained the purpose of today's inspection. The Center self reported an unusual incident involving a child who had a fainting spell during an activity at school and first aid/medical services protocols followed by the Center.

No children were present during today's inspection. Graciela stated that school's last day was on 05/29/19 and all teachers were attending two days of in-service training at the facility (05/30-05/31). Summer program will start on 06/03/19. LPA interviewed the Director, staff, reviewed a child file and obtained relevant documents.

No deficiencies were issued during today's visit. Exit Interview was conducted, where this report was reviewed and discussed with the Director who signed the report confirming receipt of documents.

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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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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