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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415249
Report Date: 07/18/2019
Date Signed: 07/18/2019 03:38:52 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:SOROYA, SHAZIAFACILITY NUMBER:
434415249
ADMINISTRATOR:SOROYA, SHAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 887-2471
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY:14CENSUS: 2DATE:
07/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Shazia SoroyaTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Shazia Soroya, Licensee, for an unannounced case management inspection. LPA also observed the Licensee's 13 year old daughter and two infant day care children in the home during today's inspection.

LPA provided the Licensee with the link for the Lead Poisoning Facts Flyer that she must provide to all parents of newly enrolled children.

http://www.cdss.ca.gov/inforesources/Child-Care-Licensing then access "quick links" and then Lead Poisoning Facts Flyer.

No deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, 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: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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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