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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709674
Report Date: 06/21/2024
Date Signed: 06/21/2024 11:06:15 AM

Document Has Been Signed on 06/21/2024 11:06 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:HEADSUP CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430709674
ADMINISTRATOR/
DIRECTOR:		RONA NUNEZFACILITY TYPE:
850
ADDRESS:2841 JUNCTION AVENUETELEPHONE:
(408) 432-1644
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 72TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
06/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Rona NunezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Rona Nunez, Director, for an unannounced case management inspection.

LPA discussed employee and children files and provided Rona with a copy of the Entrance Checklist - Child Care Centers (LIC 125) during today's inspection.

LPA reminded Rona that any new employee or enrolled child must have a physical within the 12 month period prior to employment or enrollment.

Exit interview conducted and report was reviewed with the Director, Rona Nunez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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