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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270700262
Report Date: 08/03/2022
Date Signed: 08/10/2022 12:32:44 PM

Document Has Been Signed on 08/10/2022 12:32 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:CHURCH OF THE GOOD SHEPHERD PRESCHOOLFACILITY NUMBER:
270700262
ADMINISTRATOR:RACHEL CRUZFACILITY TYPE:
850
ADDRESS:301 CORRAL DE TIERRA ROADTELEPHONE:
(831) 484-2153
CITY:SALINASSTATE: CAZIP CODE:
93908
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rachel CruzTIME COMPLETED:
11:40 AM
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on 8/3/2022 LPA Collins attempted pre-licenseing inspection. LPA was met at door by director Rachel Cruz, LPA stated the purpose of the visit; Licensee is requesting a capacity increase to license. Rachel stated she could not facilitate an inspection at this time, due to a teacher's staff/teacher training that was going on. Rachel stated she thought it the inspection would be schedule. LPA informed director Rachel these types of inspections are unannounced. LPA Called RO SJ to inform management of the situations.
Note: No children were observed LPA observed the facility from the parking lot for approximately 15 to 20 minutes . Picture were taken of the front doors only a five day menu was observed alone with LIC 610 and Personal right poster,Notice of Site visit on 4/13/2022 and Notification of Parents Rights and various COVID-19 posting.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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