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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701361
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:57:21 AM

Document Has Been Signed on 09/20/2023 11:57 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:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 154TOTAL ENROLLED CHILDREN: 156CENSUS: 113DATE:
09/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Brittany BosticTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Janette Cruz conducted an unannounced case management inspection to check the facility and met with Brittany Bostic, Director. Director provided a guided tour to LPA of indoor and outdoor areas of the facility. LPA toured the following rooms: 7, 8, 9A, 9B, 10, 11, 12, 13 and 14. LPA observed that facility was in compliance with ratio of staff to preschool children during today's inspection. Director provided LPA with current child care roster and LIC500 Personnel Report.

No deficiency was cited during today's inspection. Exit interview conducted and reviewed with Brittany Bostic, Director.

Notice of site visit given and must be posted within 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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