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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415903
Report Date: 06/29/2022
Date Signed: 06/29/2022 04:04:24 PM

Document Has Been Signed on 06/29/2022 04:04 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:CHOUDARY, ARTHIFACILITY NUMBER:
434415903
ADMINISTRATOR:ARTHI CHOUDARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 646-2373
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
06/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Arthi Choudary TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Mel Matos met with Arthi Choudary, Licensee, for an unannounced case management inspection. LPA also observed two adult assistants and 14 day care children (12 preschool & 2 school age) in the home during today's inspection.

LPA reminded that any new adult staff must complete the Mandated Reporter for Child Care Workers within 45 days of commencing employment.

No deficiencies issued during today's inspection.

Exit interview conducted and report was reviewed with the Licensee, Arthi Choudary

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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