<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415535
Report Date: 07/12/2019
Date Signed: 07/12/2019 04:04:55 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:BANUELOS, YADIRA AND CRISTANCHO, GLORIAFACILITY NUMBER:
434415535
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/12/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Yadira BanuelosTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Mel Matos met with Yadira Banuelos, co-Licensee, for an unannounced case management inspection. LPA observed five day care children (Yadira's infant child, 2 infants, and two preschool) present in the home during today's inspection.

Yadira states that she and her mother-in-law are considering applying for the large Family Child Care Home License. LPA advised Yadira that she will need to submit an updated Application for a Family Child Care Home License (LIC 279), letters verifying experience for her and Gloria Cristancho (co-Licensee & mother-in-law), and a $25 payment payable to "DSS" to initiate the request to increase the licensed capacity.

LPA also advised Gloria that a fire inspection from the city of Sunnyvale Fire Department will be requested upon receipt of the request to increase the licensed capacity and that she should inquire with the local fire department if she has any questions regarding the fire inspection process.

No deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT 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: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1