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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416695
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:54:13 AM

Document Has Been Signed on 11/21/2022 11:54 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LITTLE OAK NURSERYFACILITY NUMBER:
434416695
ADMINISTRATOR:JENNIFER POTMESILFACILITY TYPE:
830
ADDRESS:1921 CLARINDA WAYTELEPHONE:
(408) 396-1252
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 30TOTAL ENROLLED CHILDREN: 17CENSUS: 12DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer PotmesilTIME COMPLETED:
12:05 PM
NARRATIVE
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Case Management – Other inspection and met with Director, Jennifer Potmesil. The purpose of the inspection was to deliver the amended LIC 9099 which was originally issued on 4/18/2022.

After an internal Community Care Licensing Division (CCLD) Child Care Program review, it was found that the allegation and investigation finding narrative was not consistent with the reported allegation and investigation. An amended report is being provided.


NO DEFICIENCY WAS ISSUED. NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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