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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414609
Report Date: 06/16/2022
Date Signed: 06/16/2022 02:59:15 PM


Document Has Been Signed on 06/16/2022 02:59 PM - 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:METOVIC, KIMETA & ADZIJAFACILITY NUMBER:
434414609
ADMINISTRATOR:KIMETA & ADZIJAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 355-3687
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:14CENSUS: 9DATE:
06/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Kimeta MetovicTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Marilou Monico met with Licensee, Kimeta Metovic, for a Plan of Correction Inspection. The facility was cited on June 14, 2022 under Staffing Ratio and Capacity, Health & Safety (Administration of Child Day Care Licensing). Also present in the home were Licensee, Adzija Metovic, and nine (9) daycare children including four (4) infants, four (4) preschool age, and one (1) school age.

During today's inspection, LPA observed the following:
1) Two adults (both licensees) and nine daycare children (4 infants, 4 preschool age, and 1 school age)
2) Current Mandated Reporter Training certificates for both licensees and licensee's helper (H1)
3) Completed and signed Acknowledgement of Receipt of Licensing Report forms

Deficiencies under Staffing Ratio and Capacity, Health and Safety (Administration of Child Day Care Licensing) are hereby corrected and cleared.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.











SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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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