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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412947
Report Date: 11/20/2024
Date Signed: 12/09/2024 11:37:36 AM

Document Has Been Signed on 12/09/2024 11:37 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:ANTONI, STEPHANIEFACILITY NUMBER:
434412947
ADMINISTRATOR/
DIRECTOR:		ANTONI, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 394-5536
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/20/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:UnavailableTIME VISIT/
INSPECTION COMPLETED:
03:42 PM
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler made an attempted plan of corrections visit to the above licensee. Upon arrival, LPA observed no cars in the driveway or in front of the home as in previous visits. LPA rang the "ring" doorbell and showed badge to the camera. LPA waited for a response for two minutes and heard nothing inside the home or backyard where day care takes place. No one spoke through the camera either.

Licensee had previously stated to LPA that her day care hours have changed from 8am-1PM, but an updated LIC279 has not been provided to the Department to correct these changes.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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