<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413527
Report Date: 09/20/2021
Date Signed: 09/20/2021 04:01:30 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:GOOD SAMARITAN EDUCATION & ENRICHMENT PROGRAMSFACILITY NUMBER:
434413527
ADMINISTRATOR:CORIA, GUADALUPEFACILITY TYPE:
840
ADDRESS:19624 HOMESTEAD ROADTELEPHONE:
(408) 996-8290
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:24CENSUS: 0DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Guadalupe Coria & Stacey O'TooleTIME COMPLETED:
04:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
#2 Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year inspection. LPA met with Site Director, Guadalupe Coria, and Assistant Director, Stacey O'Toole, and explained the purpose of today's inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center is open Monday through Friday from 07:00 AM to 6:00 PM. Age serve is 5 to 14 years old. The school age program is licensed in Rooms 22 and 24.

LPA toured the indoor and outdoor areas. There were no school age children observed. Site Director stated that the school age program is only open during the summer. There were no bodies of water observed. Per Site Director, there were no weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Restroom for children to use were observed to be in operating condition.

Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed play equipment were in good condition and areas around the climbing structures have resilient material. Drinking water was readily available to children indoor and outdoor via water bottles.

LPA observed trash cans for solid waste had tight-fitting covers on, and were in good repair. LPA observed working smoke detector and functioning carbon monoxide detector.

As a result of this inspection, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1