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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416688
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:24:00 PM

Document Has Been Signed on 12/17/2021 12:24 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:LEARNING SPRINGS ACADEMY INC.FACILITY NUMBER:
434416688
ADMINISTRATOR:LUCIA D'SOUZAFACILITY TYPE:
840
ADDRESS:1774 FOXWORTHY AVENUE, BLDG1TELEPHONE:
(408) 979-9769
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 30TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Lucia D' SouzaTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) James Santos conducted an unannounced Required - 1 Year inspection visit at the facility today and met with Director, Lucia D’Souza.

Per Director, they are closing early today @ 1pm due to the holiday break. The facility operates a School Age (After School) Program.

While at the facility, LPA conducted a brief tour of the classrooms with the Director. LPA observed the required posted materials which includes the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus and Activity Schedule are posted prominently in the administration office.

Due to the facility closing early today, the annual inspection will be continued on a later date.


NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2021
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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