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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710074
Report Date: 09/17/2024
Date Signed: 09/17/2024 03:53:06 PM

Document Has Been Signed on 09/17/2024 03:53 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. 300
SAN JOSE, CA 95131
FACILITY NAME:PRIMARY PLUS - HIBISCUS (PRESCHOOL)FACILITY NUMBER:
430710074
ADMINISTRATOR/
DIRECTOR:		MERCEDES MENDOZAFACILITY TYPE:
850
ADDRESS:801 HIBISCUS LANETELEPHONE:
(408) 985-5998
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 213TOTAL ENROLLED CHILDREN: 213CENSUS: 68DATE:
09/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Renee TorresTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Incident inspection. LPA met with Office Admin, Ashley, and explained the reason for the inspection. Site Director, Renee Torres, arrived shortly after. The purpose of this inspection is to review a self-reported incident involving C-1 and a potential violation of personal rights. Incident was self-reported to the San Jose Regional Office on 09/10/2024.

During today's inspection, LPA conducted observation. LPA also interviewed staff, children, and parent. LPA also reviewed child's and staff's file during today's inspection. Based on the information obtained, there is not a preponderance of evidence to prove the incident did or did not occur.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Site Director Renee Torres. 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: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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