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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414612
Report Date: 06/18/2019
Date Signed: 06/18/2019 01:34:43 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:CHAVEZ, JENNYFACILITY NUMBER:
434414612
ADMINISTRATOR:CHAVEZ, JENNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 899-2885
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 0DATE:
06/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jenny ChavezTIME COMPLETED:
01:35 PM
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LPA Janet Tse met with licensee Jenny Chavez for a Case Management Inspection as one of the follow-up inspections after the meeting at the San Jose Child Care office on 03/14/2019. At arrival, Licensee told LPA that she was on vacation that the child care was closed, and refused LPA's entry to the home. LPA explained to Licensee that Licensing was not notified of the closure for vacation time; therefore, an inspection was still due. Licensee stated child care will be re-opened on 06/24/2019. LPA also advised Licensee of the $500 immediate civil penalty for zero tolerance violation if LPA is not allowed to enter the home and conduct inspection. LPA observed no day care children in the home.

LPA obtained a copy of the roster of the children today. LPA observed the last fire drill recorded on the log was done on 02/18/2019. LPA reviewed nine children's files. LPA observed LIC 9224 Acknowledgement of Receipt of Licensing Reports with parents' signatures for the reports dated 03/14/2019 and 02/08/2019 in each child's file. LPA also observed the LIC 700 Identification and Emergency Information and the LIC 995B Addendum to Notification of Parents' Rights regarding removal/exclusion of an individual with parents' signatures in each child's file.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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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