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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414131
Report Date: 09/16/2021
Date Signed: 09/16/2021 11:44:04 AM

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:SARATOGA FRENCH CULTURAL PRESCHOOLFACILITY NUMBER:
434414131
ADMINISTRATOR:BOUGACHOUCH, NADIAFACILITY TYPE:
850
ADDRESS:12850 SARATOGA AVENUETELEPHONE:
(408) 740-3350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:45CENSUS: 36DATE:
09/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:TIME COMPLETED:
11:48 AM
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LPA Pete Hernandez met with Nadia Bougachouch, Director, for an unannounced Case Management - Incident inspection. The purpose of the inspection is to review an unusual incident report, UIR, that was self reported on 9/7/2021. This incident involved C1 having and allergic reaction, use of an EpiPen and possible violation of children's rights. There were no injuries resulting from this incident.

LPA inspected the physical plant. LPA interviewed staff. LPA also reviewed incident report, children's roster, IMS plan, and child's file. Due insufficient information at this time, this incident is still under review.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, An exit interview was conducted with the licensee. A copy of this report was discussed and left with the Licensee, Nadia Bougachouch, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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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