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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434415382
Report Date:
05/17/2019
Date Signed:
05/17/2019 09:04:18 AM
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:
TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER:
434415382
ADMINISTRATOR:
HOIBERG, ELIZABETH
FACILITY TYPE:
840
ADDRESS:
8985 MONTEREY ROAD
TELEPHONE:
(408) 710-3338
CITY:
GILROY
STATE:
CA
ZIP CODE:
95020
CAPACITY:
14
CENSUS:
0
DATE:
05/17/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:01 AM
MET WITH:
Elizabeth Hoiberg
TIME COMPLETED:
09:10 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced case management other inspection. LPA met with Director Elizabeth Hoiberg and explained the reason for the inspection. The purpose of the inspection was to amend the 9099 report dated 05/16/2019 to include who LPA met with.
No deficiencies were cited as a result of today's inspection. An exit interview was conducted where this report was discussed and provided to Director Elizabeth. A notice of site visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME:
Anthony Studebaker
TELEPHONE:
(408) 324-2148
LICENSING EVALUATOR NAME:
Samantha Yip
TELEPHONE:
(408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE:
05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/17/2019
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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