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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416365
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:19:38 PM

Document Has Been Signed on 05/04/2022 01:19 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:L'ACADEMY LANGUAGE IMMERSION PRESCHOOL SCFACILITY NUMBER:
434416365
ADMINISTRATOR:HELENA GENGFACILITY TYPE:
850
ADDRESS:351 SARATOGA AVENUETELEPHONE:
(408) 916-7536
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
05/04/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Helena GengTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Dung Mac conducted a scheduled informal office meeting at the San Jose Regional Office with Helena Geng, Applicant Representative. The purpose of today's meeting was to address several items required in the application prior to conducting the pre-licensing inspection.

LPM reviewed with the Applicant Representative the missing/incomplete documents as well as items that need to be corrected. LPM provided Applicant Representative a list of revision that need to be made and discussed, included but not limited to: LIC 200A, LIC 308, LIC 309, LIC 401, LIC 403, LIC 404, Indoor sketch, LIC 610, Lease Agreement, LIC 500, Sample Menu, Job Descriptions, director's qualifications, In-Service Training, Employee Handbook, , Admission Agreement, Parent Handbook, List of Furniture & Equipment, Incidental Medical Services (IMS) Plan, and updated LIC 503 for Applicant Representative.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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