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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415238
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:02:29 PM


Document Has Been Signed on 10/27/2022 01:02 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:ABC PLAY SCHOOLFACILITY NUMBER:
434415238
ADMINISTRATOR:SHU CHEN PANFACILITY TYPE:
850
ADDRESS:3000 SOUTH BASCOM AVENUETELEPHONE:
(408) 645-6239
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:35CENSUS: 33DATE:
10/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Shu Chen PanTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) James Santos conducted an unannounced case management visit today and met Director, Shu Chen Pan.

During today's visit, LPA conducted interviews with staff and children.

No deficiencies cited. Exit interview conducted and report was reviewed and a copy was provided to Director, Shu Chen Pan.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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