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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408827
Report Date: 01/16/2024
Date Signed: 01/16/2024 12:16:32 PM


Document Has Been Signed on 01/16/2024 12:16 PM - 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:MACC PRESCHOOL EASTUS DRIVEFACILITY NUMBER:
434408827
ADMINISTRATOR:LAKSHMI SUBRAMANIANFACILITY TYPE:
850
ADDRESS:4660 EASTUS DRIVETELEPHONE:
(408) 446-4166
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:48CENSUS: 10DATE:
01/16/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Lakshmi SubramanianTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Lead Testing/Exceedance inspection. LPA met with Director Lakshmi Subramanian and explained the reason for the inspection. The purpose of this inspection is to check that Faucet D (Drinking Fountain in Room K2) was capped off due to it having a result of 7.5ppb.

During today's inspection, LPA inspected Room K2 and observed that the drinking fountain was removed and capped off. LPA observed that the drinking fountain in Room K1 was also removed and capped off. There were no other drinking water fountain on site. Director stated that there are using the kitchen sink in Room K1 and Brita filter for drinking water. There are four additional sinks for children to wash their hands.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Director Lakshmi Subramanian.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024
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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