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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410620
Report Date: 05/15/2019
Date Signed: 05/15/2019 02:09:15 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:LITTLE TREE PLAYSCHOOL, THEFACILITY NUMBER:
434410620
ADMINISTRATOR:TERESA GALLARDOFACILITY TYPE:
850
ADDRESS:7275 SANTA TERESA BLVD.TELEPHONE:
(408) 972-9200
CITY:SAN JOSESTATE: CAZIP CODE:
95139
CAPACITY:20CENSUS: 19DATE:
05/15/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Rachele WrightTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Marilou Monico, met with Licensee Representative/Site Director, Rachele Wright, for a case management inspection in response to an increase in capacity from 20 to 30 children and adding toddler option program on the license. An initial inspection was conducted on May 8, 2019 and LPA returned to the facility today to check that the diaper changing table within arm's reach of a sink has been installed/completed.

During today's inspection, LPA observed a diaper changing table within arm's reach of a sink in the toddler option room. All the other missing items on the May 8, 2019 inspection has been submitted to Licensing.

The preschool and toddler option children will be using the preschool playground at different times. LPA advised Site Director that the two programs cannot commingle at any time.

A license for 20 preschool and 10 toddler option children will be granted upon manager's review and approval.

There were no deficiencies cited.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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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