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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414162
Report Date: 06/03/2024
Date Signed: 06/03/2024 11:37:24 AM


Document Has Been Signed on 06/03/2024 11:37 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:SUHASINI RAMAKRISHNANFACILITY TYPE:
850
ADDRESS:20100 STEVENS CREEK BLVDTELEPHONE:
(408) 253-3712
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:88CENSUS: 30DATE:
06/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Suhasini RamakrishnanTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Marilou Monico met with Site Director, Suhasini Ramakrishnan, for a Case Management Inspection. Site Director self-reported an alleged incident involving two preschool age children (C-1 & C-2). LPA toured the facility and conducted interviews. Copy of children's roster and Unusual Incident Report (LIC 624) were obtained.

Due to insufficient information available at this time, the alleged incident needs further investigation.

Exit interview conducted and report was reviewed with the Site Director, Suhasini Ramakrishnan.

There were no deficiencies issued.

A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024
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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