<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415440
Report Date: 12/12/2022
Date Signed: 12/12/2022 10:07:37 AM


Document Has Been Signed on 12/12/2022 10:07 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:CUSD - MUIR CUPERDOODLE PRESCHOOLFACILITY NUMBER:
434415440
ADMINISTRATOR:MICHELLE HERRIAGEFACILITY TYPE:
850
ADDRESS:6560 HANOVER DRIVETELEPHONE:
(408) 252-3000
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:84CENSUS: 41DATE:
12/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Michelle HerriageTIME COMPLETED:
10:18 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced Case Management - Incident Inspection. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations and discuss the incident reported dated on 10/5/2022. This is also a follow up to an issue that was already resolved by the LPA and Management the week of 10/5/22. LPA met with the Site Director Michelle Herriage and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays visit. The Preschool is located on the Muir Elementary School Campus in rooms 26, 27, 29, and 30.

The Incident occurred in Room 27. After interviewing the Director and observing the restroom, The purpose of the on site observation was to evaluate that which was previously discussed with the Director. it is clear that privacy and children's rights were never in question. Children are lined up at the doorway and allowed in one at a time. No Title 22 Regulations were violated.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Licensee. A copy of this report was discussed and left with the Licensee, Michelle Herriage, whose signature on this form confirm receipt of these documents.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1