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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414506
Report Date: 08/01/2023
Date Signed: 08/01/2023 09:45:50 AM


Document Has Been Signed on 08/01/2023 09:45 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:ROBLES, MARIA ROSARIOFACILITY NUMBER:
434414506
ADMINISTRATOR:ROBLES, MARIA ROSARIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 745-7980
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:14CENSUS: 1DATE:
08/01/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria Rosario RoblesTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Mel Matos met with Maria Rosario Robles, Licensee, for an unannounced Annual/Random inspection. LPA notes that the Licensee resides in the Plaza Del Rey Mobile Home Park and public parking is located across the street from the Licensee's home. LPA was granted access to the home by the Licensee. LPA also observed one napping preschool child and Licensee's spouse (Ronald Robles) in the home during today's inspection.

Licensee states that Friday August 11, 2023 will be her last day of operation. Licensee states that the day care will be permanently closed as of August 12, 2023. Licensee provided a signed letter to LPA during today's inspection requesting closure of her license as of August 12, 2023.

Exit interview conducted and report was reviewed with the Licensee, Maria Rosario Robles . 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: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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