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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415520
Report Date: 03/02/2021
Date Signed: 03/02/2021 09:48:50 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:LOPEZ, CELIAFACILITY NUMBER:
434415520
ADMINISTRATOR:LOPEZ, CELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 912-3566
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 7DATE:
03/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Celia LopezTIME COMPLETED:
10:00 AM
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LPA Janet Tse met with licensee Celia Lopez to conduct a case management tele-inspection for the approval of the background usage with a covered patio for child care. Licensee has added a patio cover in the backyard, and fire clearance was approved on 02/10/2021 by the San Jose Fire Department. Due to the COVID-19 pandemic, this inspection was conducted via Facetime. LPA explained the nature of today's visit to Licensee.

LPA observed seven children including one infant and one school age child with Licensee and her two assistants, Belen Cortes and Sujeiry Lopez. LPA toured the indoor and outdoor of the facility. LPA observed the home was clean and hazards free for the health and safety of the day care children. The storage shed in the backyard was locked. Licensee's CPR & 1st Aid certification expires on 02/25/2022; and there was a functioning smoke and carbon monoxide detector.

The backyard with the covered patio is approved to be used for child care.

No deficiency was cited. Notice of Site Visit was issued and must be posted for 30 days.

Due to COVID 19, a copy of this Licensing report with LPA's signature alone will be emailed to Licensee; and in lieu of Licensee's signature, a read receipt of the email will serve as acknowledgement of receipt of this Licensing report by Licensee.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021
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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