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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414303
Report Date: 11/05/2021
Date Signed: 11/05/2021 03:38:50 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:LECHUGA, ESTHERFACILITY NUMBER:
434414303
ADMINISTRATOR:LECHUGA, ESTHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 706-8930
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:13CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Esther LechugaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Legal/Non-compliance. LPA met with Licensee Esther Lechuga and explained the reason for the inspection. The purpose of this inspection is Licensee came into the San Jose Regional Office for an Informal Meeting on 02/10/2020 due to children's file. Present during today's inspection were Licensee and her daughter who is visiting.

During today's inspection, LPA reviewed one child's file. LPA observed that child had all the forms in their file.

No deficiencies were cited as a result of this inspection. Exit interview conducted and report was reviewed with Licensee Esther Lechuga. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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