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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710237
Report Date: 08/17/2022
Date Signed: 08/17/2022 11:32:41 AM

Document Has Been Signed on 08/17/2022 11:32 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DE LA VEAGA CKC INC.FACILITY NUMBER:
440710237
ADMINISTRATOR:PAYA VANGFACILITY TYPE:
840
ADDRESS:1145 MORRISSEY BOULEVARDTELEPHONE:
(831) 426-7402
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 0DATE:
08/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Noel SchermannTIME COMPLETED:
11:45 AM
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Amended Facility Evaluation Report -Case Management-other:

Licensing Program Analysts (LPA) Stephanie Collins conducted a case management inspection to deliver an amended Facility Evaluation Report dated August 3rd 2022. LPA met with Site Director, Noel Schermann. LPA submitted to her the amended Facility Evaluation Report dated 8/3/2022 and collected an updated 200A which identified what classrooms will be utilized for the School Age program. (Rooms 33, #34 and #35) per management's request.


A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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