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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414117
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:09:21 PM

Document Has Been Signed on 05/10/2024 03:09 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:CHRISTOPHER STATE PRESCHOOLFACILITY NUMBER:
434414117
ADMINISTRATOR/
DIRECTOR:		CARMODY, BARBARAFACILITY TYPE:
850
ADDRESS:565 COYOTE ROADTELEPHONE:
(408) 573-3341
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:09 PM
MET WITH:Elvira CortezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst Jessica Bongardt met with Elvira Cortez, Site Director regarding a Case Management UIR that was reported to our office on 04/23/2024.Incident that was reported was C1's parents are stating that the child received a bump on the underside of the child's right arm and that it happened while the child was at school.

LPA completed staff interviews and did a file review on C1. LPA toured the inside of the classroom.

No deficiencies were cited today.

Exit interview was completed with Site Director, Elvira Cortez.

Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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