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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417026
Report Date: 08/15/2024
Date Signed: 08/15/2024 10:44:06 AM

Document Has Been Signed on 08/15/2024 10:44 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:PRIMROSE SCHOOL OF CUPERTINOFACILITY NUMBER:
434417026
ADMINISTRATOR/
DIRECTOR:		MONICA THOMPSONFACILITY TYPE:
830
ADDRESS:1002 SOUTH DE ANZA BOULEVARDTELEPHONE:
(408) 685-7133
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
08/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:13 AM
MET WITH:Monica Thompson and Sima ShahTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Executive Director, Monica Thompson and Licensee, Sima Shah, and explained the reason for the inspection. The purpose of this inspection is to amend the 809 reported dated 04/24/2024.

LPA provided the Licensee with the amended 809 report dated 04/24/2024 during today's inspection.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Licensee, Sima Shah. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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