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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414163
Report Date: 04/13/2023
Date Signed: 04/13/2023 10:27:39 AM

Document Has Been Signed on 04/13/2023 10:27 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
SAN JOSE-DAY CARE, 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: 125TOTAL ENROLLED CHILDREN: 90CENSUS: 53DATE:
04/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Y Fen (Amanda) ShihTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced Plan of Correction (POC) inspection to the facility. The facility was cited on January 12, 2023 under 101129(a)(1) Responsibility for Providing Care and Supervision. LPA met with Director, Y Fen (Amanda) Shih.

LPA received the Plan of Correction in written and records with all staff signatures on a scheduled one day title 22 supervision staff training held on 1/21/2023 prior to this visit.

LPA toured the facility. LPA observed 45 preschool children with 16 staff members (10 teachers & 6 teacher's aides) present with the children. LPA observed 53 out of 90 enrolled parents/authorized representatives signed the Acknowledgement of Receipt of Licensing Report (LIC 9224) and kept in each of the day care children file. Director stated that the form with the report were given to all the parents on the same date the school receives the deficiency, and the school will keep reminding the parents who has not yet returned to return it back to the school for completion.

As a result of this inspection, the deficiency can not be cleared as the facility has not yet received all the parents/authorized representative singed the Acknowledgement of Receipt of Licensing Report (LIC 9224).

A technical Assistance note was given to director, Y Fen (Amanda) Shih.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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