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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702544
Report Date: 06/07/2024
Date Signed: 06/07/2024 09:48:51 AM

Document Has Been Signed on 06/07/2024 09:48 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAMFACILITY NUMBER:
430702544
ADMINISTRATOR/
DIRECTOR:		BOBBI URBANOFACILITY TYPE:
840
ADDRESS:1425 LINCOLN AVETELEPHONE:
(408) 287-6999
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 200TOTAL ENROLLED CHILDREN: 200CENSUS: 66DATE:
06/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Thalia GutierrezTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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On 6/7/2024, at 9:35 AM, Licensing Program Analyst (LPA) Liridon Fici arrived unannounced to conduct a case management visit to deliver an amended report dated for 4/17/2024. LPA was greeted by Director substitute (DS), Thalia Gutierrez and explained the purpose of the visit.

LPA obtained the original report dated for 4/17/2024 and delivered amended report today, dated for 6/7/2024.

No deficiencies cited during visit.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted with DS, and this report reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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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