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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416286
Report Date: 02/22/2022
Date Signed: 02/22/2022 04:23:49 PM


Document Has Been Signed on 02/22/2022 04:23 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:NOVOA DUQUE, JOSUEFACILITY NUMBER:
434416286
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
02/22/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Josue Novoa DuqueTIME COMPLETED:
04:25 PM
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Licensing Program Managers (LPM's) Diana Stephenson, Mary Segura and Licensing Program Analysts (LPAs) Elizabeth Berumen and Mel Matos met with Licensee, Josue Novoa Duque for a scheduled informal meeting in the San Jose Regional Office. LPA Elizabeth Berumen provided Spanish translation services for this meeting.

The purpose of today's meeting was to ensure that Licensee understands title 22 regulations, and to speak about concerns regrading the inspection on February 10, 2022.

LPA's Mel Matos and Aman Sharma observed the following:
1. broken fence
2. infants using blankets while sleeping in crib
3. staff files were incomplete
4. windex (glass cleaner) stored accessible to children

Review of google search found that the licensee is not listing his facility license number on advertisement as required. Licensee was instructed to ensure that this is corrected today and any new forms of advertisement include his license number.
Licensee will be subject to unannounced inspections to ensure compliance with title 22 regulations.
Licensee was provided a copy of Licensing regulations in Spanish.

Licensee was provided with sleep regulations. The child care licensing safe sleep web page is https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
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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