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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434414645
Report Date:
10/23/2024
Date Signed:
10/24/2024 09:40:07 AM
Document Has Been Signed on
10/24/2024 09:40 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
SAN JOSE CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
WU, JUAN
FACILITY NUMBER:
434414645
ADMINISTRATOR:
WU, JUAN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 649-6477
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95132
CAPACITY:
14
CENSUS:
11
DATE:
10/23/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:40 PM
MET WITH:
Juan "Joanne" Wu
TIME COMPLETED:
03:15 PM
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Licensing Program Analysts(LPA's) Anna Morales and Shine Yu conducted a Case Management visit to hand deliver an Amended Report that was created on 9/19/24.
Exit interview was conducted with Juan "Joanne" Wu.
Notice of Site was issued and must remain posted in a visible location for 30 days.
SUPERVISOR'S NAME:
Gladys Kuizon
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Anna Morales
TELEPHONE:
(408) 334-8325
LICENSING EVALUATOR SIGNATURE:
DATE:
10/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/23/2024
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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