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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415518
Report Date: 08/18/2021
Date Signed: 08/27/2021 08:20:57 AM

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:FUENTES CANO, ANAFACILITY NUMBER:
434415518
ADMINISTRATOR:FUENTES CANO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 981-7161
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 7DATE:
08/18/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:51 AM
MET WITH:Ana Fuentes-CanoTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Janette Cruz met with Ana Fuentes-Cano, Licensee, for an unannounced Plan of Correction (POC) inspection. LPA also observed two adult assistants and seven children enrolled (1 school age 4 preschool and 2 infants) in the home during today's inspection. LPA reviewed seven children's file and obtained a copy of a Child Care Facility Roster.

The Licensee was issued one "Type A" deficiency on 07/28/2021 as a result of a substantiated complaint investigation. The deficiency was issued under Section 102416.5(f) - Staffing Ratio & Capacity.

The Licensee submitted a written Plan of Correction to LPA Cruz prior to today's inspection in which she indicates that she understands the required ratios for her large Family Child Care Home License. The Licensee states that she understands that she cannot have more than 14 day care children present at any one time.

LPA concludes that the Licensee has completed the required Plan of Correction No otherdeficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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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