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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412017
Report Date: 01/07/2020
Date Signed: 01/07/2020 03:23:25 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:OAK GROVE TAYLORFACILITY NUMBER:
434412017
ADMINISTRATOR:PALAK VYASFACILITY TYPE:
850
ADDRESS:410 SAUTNER DRIVETELEPHONE:
(408) 226-0462
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:50CENSUS: 0DATE:
01/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lozano, RosarioTIME COMPLETED:
03:45 PM
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An unannounced Annual Random Case Management Inspection was conducted on this day, by Licensing Program Analyst (LPA) Almaraz, Araceli. Facility is currently licensed for a capacity of 50. Licensing staff met with Director Lozano, Rosario. This preschool program currently operates 9:00 AM to 12 PM, Monday through Friday. There were no preschool children in care. Director states the preschool physical plant is used as a before/after school program outside of preschool hours. Director Lozano states the before /after school program is a license exempt program through the Oak Grove school district. The purpose of this visit is to re issue an LIC 421 issued on 10/16/2019. The previous LIC 421 was issued in accordance with regulation 101170(e)(1)(a) of the California Code of Regulations, Title 22, Division 12, Chapter 1. The civil penalty for this deficiency was erroneously issued on an LIC 421 and needs to be reissued on an LIC 421 BG. There will be no deficiencies nor new civil penalties issued during todays visit. Director Lozano states a package was sent with director qualifications to licensing, LPA will review the package and update this information in the system accordingly.

LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application.

There were no deficiencies issued during todays visit. LIC 421 B issued. Exit interview conducted.

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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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