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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408833
Report Date: 08/09/2019
Date Signed: 08/09/2019 03:25:41 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:CHILD KINGDOM PRE-SCHOOL/DAYCAREFACILITY NUMBER:
434408833
ADMINISTRATOR:REY, YAMILETTEFACILITY TYPE:
850
ADDRESS:4160 SENTER ROADTELEPHONE:
(408) 365-1236
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:73CENSUS: 27DATE:
08/09/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yamilette "Jamie" ReyTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Mel Matos and Dung Mac met with Yamilette "Jamie" Rey, owner/director, for an unannounced case management inspection. LPAs note that the Facility is licensed in Buildings A & B (Rooms A, B, & C).

LPAs toured the indoor and outdoor areas of the Facility during today's inspection.

LPAs reviewed four staff files (1 director, 2 teachers, and 1 aide) during today's inspection.

LPAs provided Jamie with a copy of the staff, children, and postings checklist prior to the conclusion of today's inspection.

LPAs conducted an exit interview with Jamie and advised her that no deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
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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