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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412643
Report Date: 05/02/2024
Date Signed: 05/07/2024 03:40:16 PM

Document Has Been Signed on 05/07/2024 03:40 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:DEVIREDDY, VIJAYAFACILITY NUMBER:
434412643
ADMINISTRATOR/
DIRECTOR:		DEVIREDDY, VIJAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 257-5908
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Vijaya DevireddyTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico conducted an Annual Random Inspection. LPA met with Licensee, Vijaya Devireddy, and explained the purpose of today's visit. Also present in the home were licensee's husband and one preschool age child. Licensee indicated that she is not operating her daycare for more than a year now. Licensee stated that she is only taking care of her friend's child today because the grandparent is not home. Licensee requested to place her license on inactive status. LPA explained to Licensee the conditions of inactive license. Licensee stated that she understood the conditions.

During the inspection, Licensee submitted a completed Request for Inactive Child Care License Status (LIC 9211) requesting to be inactive from 05/02/24 to 10/31/24.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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