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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710536
Report Date: 10/18/2023
Date Signed: 11/02/2023 11:49:31 AM

Document Has Been Signed on 11/02/2023 11:49 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:YWCA DAVIDSONFACILITY NUMBER:
430710536
ADMINISTRATOR:RODRIGUEZ, JEANINEFACILITY TYPE:
850
ADDRESS:375 SOUTH THIRD STREETTELEPHONE:
(408) 295-4011
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 67TOTAL ENROLLED CHILDREN: 67CENSUS: 23DATE:
10/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Lucille GabrielTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management visit to deliver a Amended Report from October 4,2023. LPA met with Program Director Lucille Gabriel and explained the nature of this visit
No deficiencies were cited at today's visit.

NOTICE OF SITE VISIT WAS ISSUED AND LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
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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