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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434412791
Report Date:
05/23/2024
Date Signed:
05/24/2024 12:32:22 PM
Document Has Been Signed on
05/24/2024 12:32 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
SAN JOSE CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
TORRES, RITA
FACILITY NUMBER:
434412791
ADMINISTRATOR/
DIRECTOR:
TORRES, RITA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(669) 216-0586
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95112
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
8
DATE:
05/23/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:
Rita Torres
TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst(LPA) Anna Morales conducted a Case Management visit and was greeted by Two staff and Licensee Rita Torres.
LPA toured the indoors and outdoors and observed 8 children (one infant and seven preschool aged children) engaging in leisure activities with the supervision of staff in the back yard. LPA reviewed a current Children's Roster and observed that there are 12 children enrolled. LPA observed that Licensee has a current 15 minute sleep log for the three infants enrolled.
LPA observed that the Acknowledge of Receipt of Licensing Reports(LIC9224) have been signed by the parent(s)/legal guardians.
No deficiencies were cited at today's visit. Exit interview was conducted with Licensee Rita Torres.
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Anna Morales
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/23/2024
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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