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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405258
Report Date: 01/15/2020
Date Signed: 01/15/2020 12:45:41 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:BARRENECHEA, ISABELFACILITY NUMBER:
434405258
ADMINISTRATOR:BARRENECHEA, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 737-2813
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 12DATE:
01/15/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Isabel BarrenecheaTIME COMPLETED:
12:55 PM
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LPA Janet Tse met with licensee Isabel Barrenechea for a Plan of Correction inspection to ensure Licensee is in compliance with the Title 22 regulation cited on 01/07/2020. LPA observed 12 children including three infants with Licensee and her two assistants, Luz Yanez-Mejia and Maria Rodriguez Velas.

LPA toured the indoor and outdoor of the home. LPA observed all items dangerous to the health and safety of children were stored inaccessible to children.

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: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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