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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434417025
Report Date:
11/08/2023
Date Signed:
11/08/2023 09:41:39 PM
Document Has Been Signed on
11/08/2023 09:41 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
SAN JOSE CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
PRIMROSE SCHOOL OF CUPERTINO
FACILITY NUMBER:
434417025
ADMINISTRATOR:
MONICA THOMPSON
FACILITY TYPE:
850
ADDRESS:
1002 SOUTH DE ANZA BOULEVARD
TELEPHONE:
(408) 685-7133
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95129
CAPACITY:
100
TOTAL ENROLLED CHILDREN:
100
CENSUS:
79
DATE:
11/08/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:15 AM
MET WITH:
Sima Shah
TIME COMPLETED:
10:45 AM
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Licensing Program Analysts (LPA's) Anna Morales and Jessica Bongardt conducted a Case Management visit to deliver a Amended Report dated on 9/21/2023. LPA's met with Owner Sima Shah and explained the nature of this visit
No deficiencies were cited at today's visit.
NOTICE OF SITE VISIT WAS ISSUED AND LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Anna Morales
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/08/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/08/2023
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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