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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413431
Report Date: 12/16/2022
Date Signed: 12/16/2022 09:12:09 AM


Document Has Been Signed on 12/16/2022 09:12 AM - 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:ZAMUDIO, MICHAELFACILITY NUMBER:
434413431
ADMINISTRATOR:ZAMUDIO, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 227-0640
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 3DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Michael ZamudioTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Janette Cruz met with Michael Zamudio, Licensee, to conduct an unannounced follow-up case management inspection. Purpose of today's inspection: deliver an amended complaint investigation findings report dated 12/14/22.

An exit interview was conducted with Director, Michael Zamudio. No other deficiencies issued during today's inspection.

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: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022
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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