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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414171
Report Date: 04/25/2022
Date Signed: 04/25/2022 03:52:11 PM


Document Has Been Signed on 04/25/2022 03:52 PM - 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:LITTLE TREE MONTESSORI INTL.SCHOOL OF SUNNYVALEFACILITY NUMBER:
434414171
ADMINISTRATOR:YINGCHIA "EVA" LIUFACILITY TYPE:
850
ADDRESS:420 S. PASTORIA AVETELEPHONE:
(408) 462-9891
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:188CENSUS: 110DATE:
04/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yingchia "Eva" LiuTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Yingchia "Eva" Liu, director, for an unannounced case management inspection.

LPA discussed COVID-19 protocols with Eva and advised Eva to consult with the Santa Clara County Health Department for update(s). LPA reminded Eva to notify the San Jose Child Care District Office if any staff or child(ren test positive for COVID-19.

Eva states that staff and children are still required to wear masks while in the Facility as an extra measure of safety.

Waiver request for centralized administrative facility license for association of staff was also discussed.

Exit interview conducted and report was reviewed with the Director, Yingchia "Eva" Liu. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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