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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417022
Report Date: 04/06/2022
Date Signed: 04/07/2022 10:48:18 AM


Document Has Been Signed on 04/07/2022 10:48 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:VIDYARAMBHFACILITY NUMBER:
434417022
ADMINISTRATOR:AJANTA DASFACILITY TYPE:
830
ADDRESS:2931 EL CAMINO REALTELEPHONE:
(408) 758-8192
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:30CENSUS: DATE:
04/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Sujatha NamboodiriTIME COMPLETED:
10:40 AM
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LPA met with Sujatha Namboodiri, Applicant Representative, and Ajanta Das, Site Director, for an unannounced pre-licensing visit. Sujatha was advised that the pre-licensing inspection will be conducted at a later date.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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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