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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416352
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:42:07 AM

Document Has Been Signed on 06/13/2022 11:42 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PLAY 'N' LEARN PRESCHOOL, INCFACILITY NUMBER:
434416352
ADMINISTRATOR:TAMMY LARIZFACILITY TYPE:
840
ADDRESS:3800 NARVAEZ AVENUETELEPHONE:
(408) 269-9004
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
06/13/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tammy LarizTIME COMPLETED:
11:30 AM
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Office Meeting to review applications for infant Center and School age applications. Met with Tammy Lariz to review items that need correction. The following items need correction prior to a prelicensing inspection and final approval of licenses. A more detailed list of corrections needed below was provided to Tammy Lariz.

1. LIC 200 needs updating.
2. LIC 309 needs updating
3. LIC 401 needs updating
4. LIC 403 a is missing please submit.
5. LIC 500 needs updating
6. Job descriptions need updating
7. Employee Handbook needs updating
8. In service Training needs updating
9. LIC 610 needs updating
10. LIC 999 needs updating.
11. Parent Handbook needs updating.
12. Admission Agreement needs updating
13. Infant Needs and Services Plan needs updating
14. Missing equipment list for the infant center please submit
15. Menus need updating
16. Missing documentation for Tammy, please submit
17. Decision on who is director.
18. Transfer criminal record clearances of Tammy and Directors.
19. School Age daily schedule does not indicate a.m. or p.m.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Mary Segura
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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