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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434404979
Report Date:
12/17/2019
Date Signed:
12/20/2019 03:13:19 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:
LOS ARROYOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER:
434404979
ADMINISTRATOR:
OKSANA OKS
FACILITY TYPE:
840
ADDRESS:
885 MORO DRIVE
TELEPHONE:
(408) 843-9005
CITY:
GILROY
STATE:
CA
ZIP CODE:
95020
CAPACITY:
26
CENSUS:
0
DATE:
12/17/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:28 PM
MET WITH:
Oksana Oks
TIME COMPLETED:
01:56 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other. LPA met with Director Oksana Oks and explained the reason for the inspection. The purpose of this inspection is to obtain a signature for amended 809 report dated 12/11/2019 page 2 due to a typo error. Amended report was delivered during today's inspection.
No deficiencies have been cited as a result of this report. An exit interview was conducted where this report was discussed and provided to Director Oksana Oks. A notice of site visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME:
Anthony Studebaker
TELEPHONE:
(408) 324-2148
LICENSING EVALUATOR NAME:
Samantha Yip
TELEPHONE:
(408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE:
12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/17/2019
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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