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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414171
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:21:36 PM


Document Has Been Signed on 10/04/2024 03:21 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:LITTLE TREE MONTESSORI INTL.SCHOOL OF SUNNYVALEFACILITY NUMBER:
434414171
ADMINISTRATOR:JACQUELINE FUNKFACILITY TYPE:
850
ADDRESS:420 S. PASTORIA AVETELEPHONE:
(408) 462-9891
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:188CENSUS: 58DATE:
10/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yingchia "Eva" LiuTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Yingchia "Eva" Liu, Director, for an unannounced case management inspection.

Eva inquired about applying for an infant component and LPA explained the process of applying for the infant component, including required fire inspection.

Eva agreed to submit an updated Personnel Report (LIC 500) and Emergency Disaster Plan (LIC 610A) to LPA Matos by Friday October 11, 2024.

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: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024
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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