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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416486
Report Date: 10/06/2021
Date Signed: 10/06/2021 04:09:41 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:CASTANO VILLAMIL, NASLYFACILITY NUMBER:
434416486
ADMINISTRATOR:NASLY CASTANO VILLAMILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 559-6485
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 3DATE:
10/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Nasly Castano VillamilTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Mel Matos and Cortney Nelson met with Nasly Castano Villamil, Licensee, for an unannounced case management inspection. LPAs also observed Licensee's 13 year old son and three infant day care children in the home during today's inspection.

The Licensee states that the children present today are the only children she has enrolled at this time. LPAs reviewed three infant children files during today's inspection and all files were complete. LPAs also reviewed a completed Child Care Facility Roster during today's inspection.

LPAs reminded the Licensee that she needs to document the 15 minute interval checks on the infant sleeping log for each individual child.

A blank copy of the Parent Consent for Administration of Medications and Medication Chart (LIC 9221) was provided to the Licensee prior to the conclusion of today's inspection.

LPAs conducted an exit interview with the Licensee and advised her that no deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE 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: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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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