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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415671
Report Date: 06/07/2023
Date Signed: 06/07/2023 09:58:01 AM


Document Has Been Signed on 06/07/2023 09:58 AM - 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:GAMA, MAYRA & ROMERO, TONIFACILITY NUMBER:
434415671
ADMINISTRATOR:MAYRA & TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 613-2556
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 5DATE:
06/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Mayra Gama & Toni RomeroTIME COMPLETED:
10:15 AM
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 Mayra Gama and Toni Romero, Licensees, for an unannounced case management inspection. Purpose of today's inspection: address ADU conversion of attached garage. LPA also observed one adult assistant (Thalia Gama) and five day care children (1 infant & 4 preschool) in the home during today's inspection.

Licensees converted the attached garage (390 sq feet) into an ADU unit that includes one bathroom. Address of ADU unit remains the same as the main home. Access to the ADU unit is through the side garage door, located close to the main entrance to the home. Copies of building permits (including final inspection approval) from the city of San Jose and an updated facility sketch have been submitted to the Department. A fire clearance approval was received from the San Jose Fire Department on June 1, 2023.

Off limits areas of the home are: master bedroom, master bathroom, 2 bedrooms, 1 bathroom, dining room, kitchen, and family room. The main areas of the day care will be the living room and attached ADU unit. Licensees will also use the front and backyard areas of the home for outdoor space. Licensees understand that children must be supervised at all times whenever they are outdoors.

LPA advised Mayra that the attached ADU unit is approved for day care use as of today's date, June 7, 2023. Exit interview conducted and report was reviewed with the Licensee, Mayra Gama.
No deficiencies issued during today's inspection. A Notice of Site Visit was given 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: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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