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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274412287
Report Date: 02/20/2025
Date Signed: 02/20/2025 05:15:58 PM

Document Has Been Signed on 02/20/2025 05:15 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:URENA, ADRIANNAFACILITY NUMBER:
274412287
ADMINISTRATOR/
DIRECTOR:		ADRIANNA URENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 578-9340
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
02/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Adrianna UrenaTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva made a Case Management inspection regarding an incident that was self supported by the facility to Licensing. The incident occurred on February 12, 2025 involving a day-care child (C1). LPA met with Licensee Adrianna Urena, and explained to her the nature of today's inspection.

Licensee was present with her assistant and with eleven children in care: one infant, seven toddlers and three schoolers. LPA toured the home, conducted interview, reviewed records, and obtained copies of documents.

A child suffered an allergic reaction during lunch time. The licensee contacted the parent and provided picture of the child showing the allergic reaction. The licensee monitored the child to ensure the reaction did not require a call to 911 for immediate response. The child was picked up shortly by their authorized representative and taken to doctor. The child was given medication and is fine to return after two days.

No deficiencies cited today

Exit Interview was conducted with the Director and APPEALS RIGHT were given.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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