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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413905
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:31:26 PM


Document Has Been Signed on 05/05/2022 03:31 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:MANTRA MONTESSORIFACILITY NUMBER:
434413905
ADMINISTRATOR:STEPHANIE WHITAKERFACILITY TYPE:
850
ADDRESS:853 GARY AVETELEPHONE:
(408) 730-2222
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:35CENSUS: 10DATE:
05/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Stephanie WhitakerTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Stephanie Whitaker, director, for an unannounced case management inspection.

LPA observed two staff and ten preschool children in the Facility during today's inspection.

LPA provided Stephanie with a Facility checklist, which includes required forms for staff, children, and postings.

No deficiencies issued during today's inspection.

Notice of site visit was issued 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: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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