Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404912
Report Date: 08/21/2015 12:00:00 AM
Date Signed 08/21/2015 12:33:17 PM

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:ROSEMARY PRESCHOOLFACILITY NUMBER:
434404912
ADMINISTRATOR:GINA PHIFACILITY TYPE:
850
ADDRESS:401 WEST HAMILTON AVENUETELEPHONE:
(408) 341-7000
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:189CENSUS: DATE:
08/21/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Gina PhiTIME COMPLETED:
12:45 PM
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LPA Esther Adeyemi made an unannounced visit to the center with regards to the unusual incident report that was received on 08/12/15. LPA met with the center director Gina Phi.

LPA discussed the director Gina Phi, LPA also interviewed staff persons.
On 07/29/15 a child was bitten at the right forearm by another child, and the bite was substantial, the child skin was broken, none of the staff / volunteer witnessed the bite, the dad was called to pick the child.

As a result of this visit, the following deficiencies are cited according to Title 22, Division 12, Chapter 3 of the CCR on the following page:

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Esther AdeyemiTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2015
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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