<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410825
Report Date: 11/17/2023
Date Signed: 11/20/2023 09:49:45 AM

Document Has Been Signed on 11/20/2023 09:49 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:EMPIRE MONTESSORI PRESCHOOLFACILITY NUMBER:
434410825
ADMINISTRATOR:CAROLINA DINOFACILITY TYPE:
850
ADDRESS:499 NORTH 11TH STREETTELEPHONE:
(408) 295-5900
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 68TOTAL ENROLLED CHILDREN: 68CENSUS: 56DATE:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Carolina Dino/Mei YangTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA)Anna Morales conducted a follow up Case Management/ Licensee Initiated inspection and met with Carolina Dino, Director and owner Mei Yang. The initial Pre licensing inspection was completed on 9/20/23 by LPA's Anna Morales and Marilou Monico. The purpose for today's inspection for Room 4: Check the following physical plant items prior to Licensure.

Approval pending on final review of Manager.

No deficiencies cited during today's visit.


SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1