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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417875
Report Date: 02/28/2025
Date Signed: 02/28/2025 11:01:32 AM

Document Has Been Signed on 02/28/2025 11:01 AM - 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:CRUZ GERONIMO, AGRIPINAFACILITY NUMBER:
274417875
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/28/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Agripina Cruz GeronimoTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Albert Mendoza conducted an announced continuation of a pre-licensing inspection to the home today. LPAs met with Agripina Cruz Geronimo, applicant, and explained the nature of today's inspection to her.
LPAs reviewed the following:
The home has a wall heater that is not barricaded, Applicant has submitted a document showing the pilot of the wall heater was put off by PG&E. Applicant understands that if eventually she wants to use the wall heater and connect the pilot she will need to barricade the wall heater.
Applicant is a co-owner of the home, Applicant stated the other two co-owners do not reside in the home, and will not obtain a clearance. Applicant has submitted today a copy of the lease agreement signed by the other two co-owners. LPAs obtained a copy of the buyers statement.
LPA's inspected the back yard and observed that applicant has made inaccessible the following areas: Has placed a fence to seclude the dogs area, has placed a fenced to make inaccessible the left side yard and the area where two storage sheds are located. LPAs observed the laundry area is located outside the home and applicant has installed shelves to place and make inaccessible detergents and cleaners.
LPAs observed the garage is off limits, is located to the right side of back yard, it is not used for cars, and applicant stated her son Jose uses it as play room.
Applicant has fixed the kitchen cabinets, and has installed a working smoke detector.

Applicant Agripina Cruz Geronimo was advised that a small Family Child Care Home will be approved upon receiving: 1) proof that applicant has removed the sharp ends of the fence that make inaccessible the far back yard.
2) Approval from a manager of the licensing program.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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