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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416284
Report Date: 03/29/2022
Date Signed: 03/29/2022 12:42:15 PM


Document Has Been Signed on 03/29/2022 12:42 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:VIDYARAMBHFACILITY NUMBER:
434416284
ADMINISTRATOR:SUJATHA NAMBOODIRIFACILITY TYPE:
830
ADDRESS:20015 STEVENS CREEK BOULEVARDTELEPHONE:
(408) 444-5019
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:12CENSUS: 4DATE:
03/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Sulakshana ShravageTIME COMPLETED:
12:55 PM
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Licensing Program Analysts (LPAs) Marilou Monico and Ofelia Calivo conducted a case management inspection to deliver an amended Facility Evaluation Report dated March 24, 2022. LPAs met with Site Director, Sulakshana Shravage.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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