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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417027
Report Date: 03/14/2022
Date Signed: 03/15/2022 03:07:02 PM


Document Has Been Signed on 03/15/2022 03:07 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:TODDLER TOWN LLCFACILITY NUMBER:
434417027
ADMINISTRATOR:SARAH VAZQUEZFACILITY TYPE:
850
ADDRESS:6920 ALMADEN EXPRESSWAYTELEPHONE:
(408) 373-3169
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:38CENSUS: DATE:
03/14/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sarah VazquezTIME COMPLETED:
10:40 AM
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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 LLC Representative, Sarah Vazquez, and Administrator, Ritipal Juneja. The purpose of today's meeting was to address several items required before the application is complete.

LPM discussed the documents that need to be updated and submitted, including but not limited to LIC 200A, LIC 309, LIC 401, LIC 610, Job Descriptions, Employee Handbook, Parent Handbook, Control of property, Incidental Medical Services, in order for the application to be complete. Sarah was provided copies of the application review and documents that need to be updated. Sarah agreed to submit all updated documents to LPA Mac by March 25, 2022 for final review of application for center license.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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