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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412947
Report Date: 12/06/2024
Date Signed: 12/06/2024 11:56:11 AM

Document Has Been Signed on 12/06/2024 11:56 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: 9DATE:
12/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:29 AM
MET WITH:Stephanie AntoniTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced plan of correction inspection. LPA was greeted by the licensee, Stephanie Antoni and granted access to the facility. LPA stated the reason for the visit was to verify plan of correction.

LPA observed the toys to be cleared out and mud removed. LPA observed the bathroom surface areas to be free of debris and dust. Cobwebs have been cleared out.

LPA reviewed records to confirm mandated reporter has been completed by all staff, immunization records are current and present for all staff and children in care.

Due to today's inspection, no deficiency was cited. Exit interview conducted with licensee, Stephanie Antoni and report was provided and reviewed.

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