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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409694
Report Date: 11/08/2021
Date Signed: 11/08/2021 03:55:14 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:DI LASCIO, BELENFACILITY NUMBER:
434409694
ADMINISTRATOR:DI LASCIO, BELENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 733-3604
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 10DATE:
11/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Belen Di LascioTIME COMPLETED:
04:15 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 (LPA) Mel Matos met with Belen Di Lascio, Licensee, for an unannounced case management inspection. LPA also observed ten day care children (4 infants & 6 preschool) and one adult assistant (Claudia Trejo) in the home during today's inspection. LPA toured the indoor and outdoor areas of the home during today's inspection.

LPA provided Licensee with a copy of the Safe Sleep regulations and the Individual Infant Sleeping Plan (LIC 9227) to the Licensee during today's inspection.

LPA advised Licensee to submit an updated Facility Sketch if she wishes to add/remove any additional space to the day care license.

Exit interview conducted and report was reviewed with the Licensee, Belen Di Lascio. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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