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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430756236
Report Date: 08/06/2021
Date Signed: 08/06/2021 10:20:06 AM

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:ROSS, VANESSAFACILITY NUMBER:
430756236
ADMINISTRATOR:ROSS, VANESSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 732-3088
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 0DATE:
08/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Vanessa RossTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Vanessa Ross, Licensee, for an unannounced case management inspection. Purpose of today's inspection: update Licensee's contact number and zip code. No day care children were present during today's inspection. The day care is closed this week and will be reopen on Monday August 9, 2021.

The Licensee submitted an updated Application for a Family Child Care Home License (LIC 279) during today's inspection. LPA updated the Licensee's contact number and zip code in the department's database prior to the conclusion of today's inspection.

A copy of the Safe Sleep regulations was also provided to the Licensee.

LPA conducted an exit interview and advised the Licensee that no deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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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