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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200391
Report Date: 06/27/2022
Date Signed: 06/27/2022 04:30:17 PM

Document Has Been Signed on 06/27/2022 04:30 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. 350
SAN JOSE, CA 95131
FACILITY NAME:EMPLOY AMERICAFACILITY NUMBER:
435200391
ADMINISTRATOR:MERITA AMITUANAIFACILITY TYPE:
775
ADDRESS:124 BLOSSOM HILL RD, STE. FTELEPHONE:
(408) 574-3950
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 45CENSUS: 0DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Attempted VisitTIME COMPLETED:
04:29 PM
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On 06/27/2022, LPA Ryker Heberle conducted an attempted visit at the facility at 04:01PM-04:22PM. LPA observed the door to be locked and did not see anybody inside the facility through the windows. LPA attempted to call the facility Administrator through the facility's listed telephone number, but was unable to make contact with staff. LPA attempted to find administrator contact information through FAS, but was unable to find additional contact information outside of their email address. LPA informed Licensing Program Manager Jackie Jin (LPM) who is currently covering for LPA's manager Sarah Yip.

Due to the Licensee/Administer not being available and no staff being present at the facility, no one was available to sign the report.

No deficiencies were cited at this time. A copy of the report was emailed to the Licensee/Administrator.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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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