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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710485
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:34:55 AM

Document Has Been Signed on 02/12/2025 10:34 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:EDENVALE HEAD STARTFACILITY NUMBER:
430710485
ADMINISTRATOR/
DIRECTOR:		LE, THUY KIM/HUYNH ALINAFACILITY TYPE:
850
ADDRESS:5319 CARRYBACK AVENUETELEPHONE:
(408) 573-4025
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 57TOTAL ENROLLED CHILDREN: 39CENSUS: 31DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Emma Monica abd Elisa HernandezTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced case management inspection to the Center with the purpose of obtaining additional information for an Unusual Incident that was reported by the Site Supervisor to Licensing Program on 2/4/25. LPA met and spoke with Emma Monica, Site Supervisor and Elisa Hernandez, Site Director. LPA observed 31 children were present and six staff members were providing supervision to them.

No deficiencies were cited today.

A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive day.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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