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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413043
Report Date: 09/18/2024
Date Signed: 09/18/2024 11:22:24 AM

Document Has Been Signed on 09/18/2024 11:22 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:SAFARI KID - SUNNYVALEFACILITY NUMBER:
434413043
ADMINISTRATOR/
DIRECTOR:		RAMAKRISHNAN, SUHASINIFACILITY TYPE:
850
ADDRESS:1271 WEST EL CAMINO REALTELEPHONE:
(650) 962-1366
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 100TOTAL ENROLLED CHILDREN: 50CENSUS: 44DATE:
09/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Guadalupe Rodriguez and Auxilia WilliamTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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Licensing Program Analyst(LPA), Mandeep Kaur conducted an unannounced case management-other. LPA met with Administrative Assistant, Guadalupe Rodriguez and Director, Auxilia William and explained the purpose of the inspection. The purpose of the inspection is to review New Site Director-Required Documentation.

LPA reviewed Director's file for Director's Qualification.

No Deficiency is issued during today's inspection.

The following items to be submitted to Licensing by October 2, 2024:
1) Copy of Director's Immunization records : Proof of results of TB test and Tdap.
2) Director's Experience Letter

Exit interview conducted and report was reviewed with Director, Auxilia William.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.




SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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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