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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434415257
Report Date:
12/19/2019
Date Signed:
12/19/2019 01:37:01 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:
RECINOS, BLANCA & JOSE
FACILITY NUMBER:
434415257
ADMINISTRATOR:
BLANCA & JOSE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 261-1033
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95117
CAPACITY:
14
CENSUS:
9
DATE:
12/19/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Amalia Alejandro
TIME COMPLETED:
01:30 PM
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LPA Janet Tse met with licensee's assistant Amalia Alejandro for a case management inspection to deliver an amended report dated 03/09/2018. There was a type on the license # in the original report. The license # has been corrected in the amended report. The amended report dated 03/09/2018 was delivered to and was signed by licensee's assistant Amalia Alejandro today.
LPA observed nine children including three infants and one school age child with licensees' assistant alone in the home. The child care home is operating out of ratio/capacity. Deficiency was cited on another report.
No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME:
Mary Segura
TELEPHONE:
(408) 324-2152
LICENSING EVALUATOR NAME:
Janet Tse
TELEPHONE:
(408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE:
12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/19/2019
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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