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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430756950
Report Date: 08/09/2023
Date Signed: 08/09/2023 02:18:14 PM


Document Has Been Signed on 08/09/2023 02:18 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:URRABAZO, ANGELITAFACILITY NUMBER:
430756950
ADMINISTRATOR:URRABAZO, ANGELITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 314-2205
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:14CENSUS: DATE:
08/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angelita UrrabazoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA)Teodoro Trujillo met with Angelita Urrabazo, Licensee, for an unannounced case management inspection for a Plan of Correction Visit. Present during today's inspection was licensee, adult Jaime and her school age who is visiting, and one (1) school age child.

LPA toured the indoor and outdoor of the home. LPA observed the day care areas outdoor have been cleaned. The condition of the child care home is safe for the health and safety of the day care children. LPA observed the outstanding LIC 9224 Acknowledgement of Receipt of Licensing Reports for type A deficiencies cited on 06/29/2023 with parents' signatures are in file.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023
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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