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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434400623
Report Date:
10/27/2023
Date Signed:
10/27/2023 11:57:06 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
10/27/2023 11:57 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:
CEJA, MARTHA & FEDERICO
FACILITY NUMBER:
434400623
ADMINISTRATOR:
CEJA, MARTHA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 281-7328
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95123
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
0
CENSUS:
0
DATE:
10/27/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:35 AM
MET WITH:
Martha and Federico Ceja
TIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee's Martha and Federico Ceja for a required one year visit. LPA explained the nature of the visit. Present were licensees only. Licensee states she has not cared for children since August and is only caring for her grandchildren when they come.
Licensee Martha states she is no longer caring for children and is going to dedicate her time to her grandchildren only. She states she cared for children of one family in August but they did not come all the time. Licensee Martha stated she would like to terminate her license. LPA requested licensee's surrender license and write a note stating they would like to close. LPA obtained license and note during visit.
No deficiency was cited.
SUPERVISORS NAME
:
Susy Cervantes
LICENSING EVALUATOR NAME
:
Deanna Villagrana
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/27/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/27/2023
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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