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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709268
Report Date: 12/07/2023
Date Signed: 12/11/2023 08:49:49 AM

Document Has Been Signed on 12/11/2023 08:49 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:LOTUS PRESCHOOLFACILITY NUMBER:
430709268
ADMINISTRATOR:LYNNE YAMAICHIFACILITY TYPE:
850
ADDRESS:639 NORTH FIFTH STREETTELEPHONE:
(408) 293-1612
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
12/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lynne Yamaichi,Program DirectorTIME COMPLETED:
03:25 PM
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Licensing Program Analysts(LPA's)Anna Morales and Doni Fici conducted a Case Management inspection regarding an Unusual Incident that was reported by the facility to Licensing on 12/6/2023. LPA's was greeted by Director Lynne Yamaichi. LPA's toured the facility, interviewed staff and reviewed files.

No deficiencies were cited during today's inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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