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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415272
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:01:15 PM


Document Has Been Signed on 05/23/2023 04:01 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:ELIZALDE, YESSICAFACILITY NUMBER:
434415272
ADMINISTRATOR:ELIZALDE, YESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 903-9413
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: DATE:
05/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Yessica ElizaldeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Teodoro Trujillo met with Yessica Elizalde, Licensee, for an unannounced Plan of Correction (POC) visit. Present were licensee, and assistant Mari Cruz with 7 children: 7 pre school age, 1 pre-school age child left and licensee school age child arrived during POC visit.

LPA provided licensee the Letter of Deficiency Citations Cleared for citations from 04/21/23 site visit, section 102425(j)(2)(D)(c), 102416.3(a)(6), and 102417(g)(8) today.

No deficiencies were cited during today's visit. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

Exit interview conducted and report was reviewed in Spanish with the licensee, Yessica Elizalde. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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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