<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403022
Report Date: 02/16/2023
Date Signed: 02/16/2023 01:17:11 PM


Document Has Been Signed on 02/16/2023 01:17 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:FERNANDEZ, MARISSAFACILITY NUMBER:
434403022
ADMINISTRATOR:FERNANDEZ, MARISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 216-9154
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:14CENSUS: 0DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marissa FernandezTIME COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/16/2023 LPA'S Stephanie Collins and Farida Raja, met with licensee Marissa Fernandez and explained the purpose of the visit. (Annual Inspection) Licensee stated she has been closed since February of 2022. Licensee submitted her license at time of inspection. NO children were observed or heard in the home.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1