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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410442
Report Date: 05/15/2023
Date Signed: 05/15/2023 12:26:49 PM

Document Has Been Signed on 05/15/2023 12:26 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:SUAZO, SOFIAFACILITY NUMBER:
434410442
ADMINISTRATOR:SUAZO, SOFIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 249-0353
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
05/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Sofia SuazoTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Marilou Monico met with Licensee, Sofia Suazo, and conducted a Plan of Correction Inspection. Licensee was cited on May 4, 2023 under Staffing Ratio and Capacity, Personnel Requirements, Health & Safety, and Child's Records.

During today's inspection, LPA observed the following:
1) Licensee present in the home with six (6) daycare children including two (2) infants and four (4) preschool age.
2) Completed and signed required Licensing documents for Child #7 and #8.
3) Licensee's current Pediatric CPR and First Aid certifications with an expiration date of May 7, 2025.
4) Signed Acknowledgement of Receipt of Licensing Report (LIC 9224) in the children's files.

The deficiencies under Staffing Ratio and Capacity, Personnel Requirements, and Child's Records are hereby corrected and cleared.

There were no deficiencies cited.

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: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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