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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404018
Report Date: 10/04/2019
Date Signed: 10/04/2019 02:58:24 PM

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:CARDOZA, MARTHAFACILITY NUMBER:
434404018
ADMINISTRATOR:CARDOZA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 963-1998
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 10DATE:
10/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Olga MataTIME COMPLETED:
03:05 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
LPA Janet Tse met with licensee's assistant Olga Mata for a case management inspection for the approval of the usage of three additional rooms: the living room, the kitchen, and the dining room. LPA explained the nature of today's visit to the assistant. Licensee was not in the home during the inspection. LPA observed ten children including three infants with two assistants, Olga Mata and Evelin Espinoza. The child care home has previously obtained fire clearance and approval from the San Jose Fire Department for the usage of the kitchen, hallway, bathroom, day care area, dining room, back yard, and the play area. Building permits were pulled with the City of San Jose by the fire department. Rooms not approved by the fire department are the kids rooms 2 and 1, and the master bedroom.

LPA toured the indoor and observed the kitchen, living room, and dining room are clean and orderly with ventilation for the safety and comfort of the children. Items dangerous to the health and safety of the children were stored inaccessible to children.

The addition of kitchen, living room, and dining room are approved for day care use.

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: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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