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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416506
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:17:03 PM

Document Has Been Signed on 05/09/2022 03:17 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:BERKMAN, MICHELLEFACILITY NUMBER:
434416506
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Michelle BerkmanTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Applicant, Michelle Berkman, for an announced follow up prelicensing inspection at 529 Anacapa Ter, Sunnyvale, CA 94085.

Applicant's initial prelicensing inspection was completed on April 28, 2022 and the Applicant was advised that the following items needed to be completed prior to a small Family Child Care Home license being approved:

1) Air conditioner unit in the backyard has been barricaded.
2) Left side section of the backyard needs to be barricaded.
3) Thorny weeds and overgrown rose bushes have been cut back or removed.
4) Updated Facility sketches have been submitted to LPA

LPA toured the backyard area of the home with the Applicant during today's inspection and observed the following:

1) Air conditioner unit in the backyard has been barricaded.
2) Left side section of the backyard has been barricaded.
3) Thorny weeds and overgrown rose bushes have been cut back or removed.

Updated Facility sketches were also provided to LPA during today's inspection.

It is concluded that the Applicant has completed the required items and thus a small Family Child Care Home is approved effective today (May 9, 2022). LPA advised the Applicant that a license will be mailed to her within 5-7 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2022
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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