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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416500
Report Date: 05/11/2022
Date Signed: 05/11/2022 03:43:19 PM

Document Has Been Signed on 05/11/2022 03:43 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:SHIRVANTE, DIVYAFACILITY NUMBER:
434416500
ADMINISTRATOR:DIVYA SHIRVANTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 265-7546
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
05/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Divya ShirvanteTIME COMPLETED:
04:00 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 Divya Shirvante, Licensee, for an unannounced case management inspection. LPA also observed eight day care children (1 infant, 5 preschool, and 2 school age) in the home during today's inspection.

LPA provided a copy of the Criminal Background Clearance Transfer Request (LIC 9182) form to the Licensee prior to the conclusion of today's inspection. Licensee states that she is registered with Guardian (Department's online portal for fingerprint clearances) and understands that she can also associate staff to her license through the Guardian system.

No deficiencies issued during today's inspection.

Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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