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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430756950
Report Date: 12/09/2024
Date Signed: 12/09/2024 10:52:15 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/09/2024 10:52 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:URRABAZO, ANGELITAFACILITY NUMBER:
430756950
ADMINISTRATOR/
DIRECTOR:		URRABAZO, ANGELITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 314-2205
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Angelita UrrabazoTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Deanna Villagrana and Pedro Solorio-Gutierrez met with licensee Angelita Urrabazo for an annual/random visit. LPAs explained the nature of the visit. Present were licensee, a man who rents a room and licensee's caregiver. LPAs did not observe any children in the home.

Licensee stated she has not cared for children since the beginning of the pandemic due to having an accident and not being able to care for children. She stated she only has her granddaughter occasionally. Licensee stated she surrendered her license last Monday at the office. LPAs observed a forfeiture letter was created by LPM Susy Cervantes on 12/06/2024. LPAs reminded licensee she could only care for children of her immediate family and/or one family without a license.
Susy CervantesTELEPHONE: (408) -32-2152
Deanna VillagranaTELEPHONE: (408) 335-9890
DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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