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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415767
Report Date: 04/29/2021
Date Signed: 04/29/2021 02:48:58 PM

Document Has Been Signed on 04/29/2021 02:48 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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
434415767
ADMINISTRATOR:SHAYLYNN LUCASFACILITY TYPE:
850
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/29/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Teresa AddisonTIME COMPLETED:
02:27 PM
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On 04/29/2021 at 2PM, Regional Manager (RM) Tony Studebaker and Licensing Program Analyst (LPA) Samantha Yip conducted an announced Office visit. Due to COVID-19 and shelter in place, a tele-conference was conducted via Microsoft Teams. RM and LPA met with District Manager, Teresa Addison, and explained the reason for the tele-conference. An Non-Compliance Conference (NCC) was conducted via Microsoft Teams on 04/29/2021.

An LIC 9111: Non-Compliance Conference Summary was generated and is available in the public file.

An exit interview was conducted with District Manager, Teresa Addison, where this report was discussed. RM informed District Manager that a copy of this report will be emailed to her. Facility's reply within 24 hours to the email will serve as acknowledgement that the report was received.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2021
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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