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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414766
Report Date: 11/14/2022
Date Signed: 11/14/2022 11:03:42 AM


Document Has Been Signed on 11/14/2022 11:03 AM - 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:RECIO, DIANA & ALEXANDER, VALERIEFACILITY NUMBER:
274414766
ADMINISTRATOR:DIANA R & VALERIE AFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 676-7843
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY:14CENSUS: 2DATE:
11/14/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Diana RecioTIME COMPLETED:
11:10 AM
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On 11/14/2022 at 10:30 AM, Licensing Program Analyst (LPA) Susy Cervantes, met with licensee, Diana Recio, for an annual inspection and explain the reason for the visit to them. Present was licensee and her two grandchildren.

After conversing with the licensee, the licensee has decided to surrender their license. LPA received their license and a letter stating they are surrendering their license.


No deficiencies were cited during today's visit. Exit interview conducted and report was reviewed with the licensee, Diana Recio.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2019
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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