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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417517
Report Date: 09/02/2026
Date Signed: 09/02/2026 02:05:04 PM

Document Has Been Signed on 09/02/2026 02:05 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:TAPIA, RAFAELFACILITY NUMBER:
274417517
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
09/02/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Rafael TapiaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On September 2, 2026, Licensing Program Analyst (LPA) Dongzhu Li conducted an unannounced Case Management Licensee-Initiated Inspection in response to a request to increase capacity from 8 to 14 children. LPA Dongzhu Li met with Licensee Rafael Tapia, explained the purpose of the visit, and was granted access to the home. No children were present.

The licensee, Rafael, stated that there have been no children in the facility since June 2026. The licensee stated that he is currently awaiting referrals from state-funded programs. These programs are unable to refer children to the facility at this time due to limited funding availability. The licensee is also awaiting enrollment in programs to increase referrals and enrollment. Some of the programs he is pursuing include Go Kids and CAPSL. The licensee stated that this is a good time to increase capacity while he is on the waitlist for the program to refer more kids. Once enrollment increases, the facility will have the capacity to accommodate additional children.

Fire clearance for the requested capacity was granted on August 12, 2026. The licensee stated that no firearms or ammunition are present in the home and that smoking is not permitted. Last fire drill was conducted on 06/07/2026.

Licensee stated that the facility operates Monday through Sunday 5:00 AM-6:00 PM. The facility provides care for children ranging in age from newborn to 12 years. LPA Dongzhu Li obtained the children's roster and reviewed children's files. All files were found to be complete at the time of review.

Licensee CPR/First Aid certification is valid through 08/18/28 and required mandated reporter training is current through 05/22/2027. LPA Dongzhu reminded the licensee of the two-year renewal requirement.

Continued on 809-C
Gladys Kuizon
Dongzhu Li
DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: TAPIA, RAFAEL
FACILITY NUMBER: 274417517
VISIT DATE: 09/02/2026
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The home is a single-story residence. LPA observed the home to be clean, safe, and adequately ventilated. LPA observed one barricaded heater in the living room. Off-limits areas are bedroom and front yard. On limit areas are kitchen, living room, bathroom and outdoor play areas near by the living room. All off limit areas will be inaccessible by closed and/or locked doors and with visual supervision. Hazardous items were secured and inaccessible to children.

LPA also observed a functional 3A40BC fire extinguisher, which is valid through 12/27/2029, functioning smoke and carbon monoxide detectors. LPA provided and reviewed applicable licensing requirements with the licensee, including the temporary absence provision effective 07/01/2026, which limits a temporary absence from the FCCH to no more than 20% of the facility’s operating hours in any given month and is subject to applicable conditions and requirements.

No deficiencies were cited. A notice of site visit was issued and must remain posted near the main door for 30 days. An exit interview was conducted, and the report was reviewed with the licensee. Appeal rights were provided.

A Large Family Child Care Home license with a capacity of 14 children will be approved pending management review and approval.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Dongzhu Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC809 (FAS) - (06/04)
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