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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413380
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:18:25 PM

Document Has Been Signed on 10/25/2023 03:18 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FUSHIKI, MARIAFACILITY NUMBER:
434413380
ADMINISTRATOR:FUSHIKI, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 390-3435
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria FushikiTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management inspection regarding an Unusual Incident that was reported by the facility to Licensing on 9/21/2023. LPA met with Licensee Maria Fushiki.

The incident occurred on September 20, 2023. LPA observed three infants and two preschool aged children and three staff( including Licensee) engaging in activities.

Based on interviews and evidence gathered, there is no preponderance of evidence to prove that staff violated a child's personal rights.

As a result of this inspection, there were no deficiencies cited.


A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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