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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434417104
Report Date:
02/28/2024
Date Signed:
02/29/2024 03:25:35 PM
Document Has Been Signed on
02/29/2024 03:25 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:
HUGHES EARLY LEARNING PROGRAM
FACILITY NUMBER:
434417104
ADMINISTRATOR:
NANCY MORIN-ROMAN
FACILITY TYPE:
830
ADDRESS:
4949 CALLE DE ESCUELA # 27
TELEPHONE:
(408) 423-1516
CITY:
SANTA CLARA
STATE:
CA
ZIP CODE:
95054
CAPACITY:
12
TOTAL ENROLLED CHILDREN:
12
CENSUS:
3
DATE:
02/28/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Jennifer Ta
TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA ) Anna Morales conducted a Case Management visit to deliver an Amended Report (LIC809) for 2/27/24. LPA notes that on this report LPA noted Census was 9 and it should have been Census for 3.
LPA Morales conducted an Exit Interview with Jennifer Ta.
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Anna Morales
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/28/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
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of
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