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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415126
Report Date: 09/19/2022
Date Signed: 09/19/2022 11:50:12 AM


Document Has Been Signed on 09/19/2022 11:50 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:PRECIOUS MOMENTS PRESCHOOLFACILITY NUMBER:
434415126
ADMINISTRATOR:PRIYANKA BANSALFACILITY TYPE:
850
ADDRESS:330 SOUTH MONROE STREETTELEPHONE:
(408) 320-2149
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:36CENSUS: 27DATE:
09/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Priyanka BansalTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Marilou Monico met with Licensee Representative, Priyanka Bansal, for a Plan of Correction Inspection. The facility was cited on September 12, 2022 under Responsibility for Providing Care and Supervision and Criminal Record Clearance.

During today's inspection, LPA observed the following:
1) Licensee Representative/teacher supervising 12 children in Classroom 3
2) One fully qualified teacher and a teacher's aide supervising 15 children in Classroom 1
3) Completed and signed Acknowledgement of Receipt of Licensing Report forms

LPA reviewed two staff files and completed one Evaluation of Teacher Qualifications.

Deficiencies under Responsibility for Providing Care and Supervision and Criminal Record Clearance are hereby corrected and cleared.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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