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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417124
Report Date: 12/14/2023
Date Signed: 12/14/2023 02:56:57 PM

Document Has Been Signed on 12/14/2023 02:56 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOLFACILITY NUMBER:
434417124
ADMINISTRATOR:YAN GONGFACILITY TYPE:
850
ADDRESS:2555 MOORPARK AVENUETELEPHONE:
(408) 398-2033
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/14/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yan GongTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Oscar Huang conducted an announced follow up Pre-licensing inspection to the facility today. LPA met with Yan Gong Applicant Representative and explained the nature of today's inspection.

The initial pre-licensing inspection was completed on September 27, 2023. The facility is applying for a license for total capacity of 83 children (59 preschoolers & 24 toddlers). LPA toured and inspected the facility both indoor and outdoor playground areas with the Applicant Representative. LPA noted that all the incomplete items requested in the initial pre-licensing inspection have been completed during today’s follow-up inspection except that Applicant Representative requested to replace the applicant of director during the application process.

LPAs conducted an exit Interview and advised Yan Gong Application Representative that a license for 83 preschool children (59 preschoolers & 24 toddler) will be approved upon completion of the following items and management review and approval:



1) Submit the applicant of director's Health Screening Report - Facility Personnel (LIC 503)
2) Submit the applicant of director's Signed Copy of Employee Rights (LIC 9052)
3) Submit the applicant of director's Evaluation of Director Qualifications (LIC 9096)
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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