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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412530
Report Date: 11/26/2019
Date Signed: 11/26/2019 08:19:44 AM

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:LAFOSSE, MILAGROSFACILITY NUMBER:
434412530
ADMINISTRATOR:LAFOSSE, MILAGROSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 266-2524
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 3DATE:
11/26/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Milagros LafosseTIME COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Stephanie Rangel met with licensee, Milagros Lafosse for a case management inspection. Ms. Lafosse is making bedroom #3 and #2 from off limits to "on limits." Both rooms are safe for children.

Updated sketch was submitted to CCL prior to today's inspection. Updated fire clearance was granted on 11/14/19 by the San Jose Fire Department to add the two rooms onto the clearance. Off limits area of the home is now the upstairs and garage only. Off limit area outside the facility is a narrow back yard which is inaccessible to children by a gate.

No deficiencies cited.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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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