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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414163
Report Date: 01/07/2022
Date Signed: 01/07/2022 03:17:14 PM

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:LITTLE TREE BILINGUAL MONTESSORIFACILITY NUMBER:
434414163
ADMINISTRATOR:Y FEN SHIHFACILITY TYPE:
850
ADDRESS:20111 STEVENS CREEK BLVD.#150&TELEPHONE:
(408) 996-3399
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:125CENSUS: 70DATE:
01/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Hui RenTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Oscar Huang met with substitute Site Director, Hui Ren for a case management visit in response to an usual incident repot submitted to the office on 12/15/2021.

During the visit, LPA interviewed staff, and obtained copies of pertinent documents.

Due to insufficient information available at this time, the incident needs further investigation.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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