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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415847
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:57:41 PM


Document Has Been Signed on 09/14/2023 01:57 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:AVALOS, MARIA DEL CARMEN & CERNA, JUANAFACILITY NUMBER:
434415847
ADMINISTRATOR:AVALOS, MARIA DEL CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 346-2243
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 10DATE:
09/14/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Maria Del Carmen AvalosTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Legal/Non-compliance inspection. LPA met with Licensee Maria Del Carmen Avalos and explained the reason of the inspection. The purpose of this inspection is Licensees had a informal meeting with the San Jose Regional Office in regards to ratio and capacity. Present during today's inspection were Licensee, her assistant, and 10 children, whom one was infant age. Facility was within ratio and capacity during today's inspection. LPA also reviewed children's files.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Licensee Maria Del Carmen Avalos. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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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