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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414162
Report Date: 04/12/2022
Date Signed: 05/26/2022 08:21:49 AM


Document Has Been Signed on 05/26/2022 08:21 AM - 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:SAFARI KIDFACILITY NUMBER:
434414162
ADMINISTRATOR:MUDDEEREGOWDA, RASHMIFACILITY TYPE:
850
ADDRESS:20100 STEVENS CREEK BLVDTELEPHONE:
(408) 253-3712
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:96CENSUS: 0DATE:
04/12/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Auxilli William TIME COMPLETED:
12:33 PM
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 Licensing Program Analyst (LPA) Stephanie Collins conducted a scheduled informal office meeting at the San Jose Regional Office with LLC Representative, Administer Auxilla William from Safari Kids . The purpose of today's meeting was for Ms. Williams to drop off required A and B documents. The following items were check-off and discussed . LIC 200A, clearly identify Director, ( Ensure Director package is complete), LIC 401, LIC 610, LIC 500, Updated Plan of Operations- Parent Handbook, (requirements for Preschool Program with Toddler Components per regulations for children ages 18-24 month) Needs and services plan, Medication Policy/ IMS etc, Job Descriptions- (Teacher/Toddlers Teachers/ Director required extra educational requirements (3 Semester units infant care each position), , Employee Handbook Updates, Food Services, Admission Policies- Auxilla was provided copies of today’s file review. Licensee was informed LPM Mary could not attended the meeting today , however, would be reviewing todays revisions and updates.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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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