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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408105
Report Date: 06/12/2024
Date Signed: 06/12/2024 04:06:16 PM

Document Has Been Signed on 06/12/2024 04:06 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:MENDOZA, FRANCESFACILITY NUMBER:
434408105
ADMINISTRATOR/
DIRECTOR:		MENDOZA, FRANCESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 509-9702
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
06/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Frances MendozaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Marilou Monico conducted a Plan of Correction inspection. LPA met with Licensee, Frances Mendoza. LPA toured the facility. Also present in the home were two adult assistants and 10 daycare children: 2 infants and 8 preschool age. Licensee was cited on June 4, 2024 under Staffing Ratio and Capacity.

The deficiency under Staffing Ratio and Capacity is hereby corrected and cleared.

There were no deficiencies cited.

Exit interview conducted and report was reviewed with Licensee, Frances Mendoza.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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