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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415594
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:46:57 PM


Document Has Been Signed on 05/17/2023 03:46 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:PRECIOUS MOMENTS PRESCHOOL LLCFACILITY NUMBER:
434415594
ADMINISTRATOR:THUONG LEFACILITY TYPE:
850
ADDRESS:830 WEST EVELYN AVENUETELEPHONE:
(408) 685-2261
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:30CENSUS: 26DATE:
05/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Priyanka BansalTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Priyanka Bansal, Licensee representative, for an unannounced case management inspection.

LPA toured the Facility and observed 11 toddler children with two teachers in the Toddler Room (Brown Room), 7 preschool children in the Green Room with one teacher, and 8 preschool children in the Orange Room with Priyanka (director qualified) and one aide (no ECE units completed).

LPA reviewed five staff files during today's inspection to verify staff qualifications during today's inspection..

Exit interview conducted and report was reviewed with the Licensee representative, Priyanka Bansal.

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: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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