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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417020
Report Date: 03/28/2022
Date Signed: 03/28/2022 03:11:55 PM

Document Has Been Signed on 03/28/2022 03:11 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:AGAPE PLAYSKOOLFACILITY NUMBER:
434417020
ADMINISTRATOR:ADLIN SOFIA NETTOFACILITY TYPE:
850
ADDRESS:181 EAST TASMAN DRIVE #70TELEPHONE:
(669) 295-8697
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Aldin Netto, TIME COMPLETED:
03:15 PM
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Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Dung Mac conducted a scheduled informal office meeting at the San Jose Regional Office with Aldin Netto, LLC Manager. The purpose of today's meeting was to address several items required before a license will be approved.

LPM reviewed with the applicant the missing/incomplete documents as well as items that need to be corrected. LPM provided applicant a list of revision that need to be made and discussed, but is not limited to: LIC 200A, Lease Agreement, LIC 610, Employee Handbook, Job Descriptions, LIC 401, LIC 403, LIC 404, Parent Handbook, Admission Agreement, In-Service Training, and Incidental Medical Services. The Heritage program was also discussed with the Applicant. Aldin understands that both the Heritage and preschool programs are separate programs and that the children cannot be commingled in the facility.

Applicant agreed to submit all updated documents by April 4, 2022.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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