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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409633
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:17:56 PM


Document Has Been Signed on 09/29/2022 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CASTRO, KIMFACILITY NUMBER:
434409633
ADMINISTRATOR:CASTRO, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 600-8280
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 1DATE:
09/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Kim CastroTIME COMPLETED:
01:40 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
Licensing Program Analyst Janette Cruz met with Kim Castro, Licensee, to conduct an unannounced case management to deliver an amended report for the case management report dated 9/9/22. LPA toured indoor and outdoor areas of the facility. LPA observed one infant present with the Licensee. LPA conducted a child's file review.

No deficiency was cited during today's inspection. An exit interview was conducted with Kim Castro, Licensee.


A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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