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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417009
Report Date: 09/21/2021
Date Signed: 11/08/2021 12:47:41 PM

Document Has Been Signed on 11/08/2021 12:47 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:NOAH'S ARK CHILDREN LEARNING CENTERFACILITY NUMBER:
434417009
ADMINISTRATOR:CHIAYI LIFACILITY TYPE:
850
ADDRESS:560 HARRISON AVENUETELEPHONE:
(408) 691-3808
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
09/21/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:ChiaYi Li, Applicant RepresentativeTIME COMPLETED:
10:51 AM
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Licensing Program Analyst (LPA) conducted an announced Office meeting with ChiaYi Li, Applicant Representative, at the San Jose Regional Office today to discuss the preschool and infant application that was submitted to the Department on August 20, 2021.

LPA discussed with ChiaYi the items that need to be submitted in order for the application to be complete.

The following items needs to be submitted:
  2. Application (LIC 200A)
  3. Administration Organization (LIC 309)
  4. Monthly Operating Statement (LIC 401)
  5. Personnel Report (LIC 500)
  6. Emergency Disaster Plan (LIC 610A)
  7. In-Service Training Plan
  8. Parent Handbook
  9. Admission Policies
8. Discipline Policies
9. Admission Agreement
10. Control of Property
11. Indoor/Outdoor sketches
12. List of furniture and Equipment
13. Sample Menu

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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