<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434416175
Report Date:
11/02/2021
Date Signed:
11/09/2021 01:59:18 PM
Document Has Been Signed on
11/09/2021 01:59 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
CCLD Regional Office
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
SJB - JAMES LICK CHILD DEVELOPMENT CENTER
FACILITY NUMBER:
434416175
ADMINISTRATOR:
PATRICIA KEITH
FACILITY TYPE:
850
ADDRESS:
57 NORTH WHITE ROAD
TELEPHONE:
(408) 928-5221
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95127
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
24
CENSUS:
DATE:
11/02/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Patricia Keith
TIME COMPLETED:
12:45 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
ON 11/02/2021 LPA Collins met with site Director Patricia Keith to amended Facility Report written on 10/14/2021. The Toddler Component's square footage failed to be added to the square footage of the Preschools Total Activity space.
SUPERVISORS NAME
:
Sandy Knight
LICENSING EVALUATOR NAME
:
Stephanie Collins
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/02/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/02/2021
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