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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404307
Report Date: 09/21/2022
Date Signed: 09/21/2022 12:12:27 PM

Document Has Been Signed on 09/21/2022 12:12 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:CASA DI MIR MONTESSORI ELEMENTARY SCHOOLFACILITY NUMBER:
434404307
ADMINISTRATOR:SUNITA AUSTINFACILITY TYPE:
850
ADDRESS:90 EAST LATIMER AVENUETELEPHONE:
(408) 370-3073
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 60TOTAL ENROLLED CHILDREN: 53CENSUS: 44DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Joy YapTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced case management visit today and met with Director, Joy Yap. The purpose of today's visit was in regards to the clearance status for a staff (S1).

During today's visit, LPA spoke with Director, Joy Yap and also with HR Director.

Due to insufficient information at this time, this case management needs further investigation.

No deficiencies cited. Exit interview conducted and report was reviewed and a copy of this report was provided to Director.


A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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