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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354404835
Report Date: 07/27/2022
Date Signed: 07/29/2022 08:48:46 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/29/2022 08:48 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:CEJA, BLANCAFACILITY NUMBER:
354404835
ADMINISTRATOR:CEJA, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 637-1634
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:14CENSUS: 2DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Blanca CejaTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Blanca Ceja for a required one year visit. LPA explained the reason for the visit. Present were licensee, licensee's husband, licensee's adult daughter with two grandchildren ages 2 and 1 years old.

Licensee stated she has not cared for children since December 7, 2021. She stated she will only be caring for her two grandchildren and would like to close her license as of today.
LPA requested her license and a letter stating she would like to close. Licensee stated she no longer has her license and believes she may have tossed it since she was no longer taking care of children and removed her signs. LPA did not observe any immediate hazards to children.

No citations were issued during visit.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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