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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413905
Report Date: 07/15/2022
Date Signed: 07/15/2022 02:34:49 PM


Document Has Been Signed on 07/15/2022 02:34 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: 4DATE:
07/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Zeenat ShaikTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced case management inspection. LPA met with Zeenat Shaik, teacher, and explained the nature of today's inspection to her. LPA also observed four napping preschool children and one additional teacher inside the Facility during today's inspection.

LPA reviewed two teacher files during today's inspection. Both teachers, including Zeenat, are fully qualified. Zeenat also has valid CPR/First Aid certifications (expiration: 10/30/2023).
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: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
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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