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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413527
Report Date: 07/10/2024
Date Signed: 07/10/2024 03:34:21 PM

Document Has Been Signed on 07/10/2024 03:34 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:GOOD SAMARITAN EDUCATION & ENRICHMENT PROGRAMSFACILITY NUMBER:
434413527
ADMINISTRATOR/
DIRECTOR:		CORIA, GUADALUPEFACILITY TYPE:
840
ADDRESS:19624 HOMESTEAD ROADTELEPHONE:
(408) 996-8290
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 24TOTAL ENROLLED CHILDREN: 17CENSUS: 9DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:32 PM
MET WITH:Guadalupe Coria & Stacey BelgerTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Case Management Inspection. LPA met with Site Director, Guadalupe Coria, and Assistant Director, Stacey Belger. LPA toured the facility. LPA observed that the teacher-child ratio was in compliance.

LPA reviewed files for the children and staff. A copy of children's roster was obtained.

As 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: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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