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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710458
Report Date: 02/28/2024
Date Signed: 02/29/2024 03:25:58 PM

Document Has Been Signed on 02/29/2024 03:25 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HUGHES STATE PRESCHOOLFACILITY NUMBER:
430710458
ADMINISTRATOR:ADRIANA SALASFACILITY TYPE:
850
ADDRESS:4949 CALLE DE ESCUELATELEPHONE:
(408) 423-1518
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 14DATE:
02/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Joanie NellisTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA ) Anna Morales conducted a Case Management visit to deliver an Amended Report (LIC809) for 2/27/24. LPA notes that on this report LPA did not note Classroom 25 was operating. During today's visit, LPA observed Classroom 25 and observed five children with two staff.
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Exit Interview was conducted with Director Joanie Nellis
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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