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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413889
Report Date: 08/22/2024
Date Signed: 08/22/2024 05:27:37 PM

Document Has Been Signed on 08/22/2024 05:27 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:ARMENTA, JULIEFACILITY NUMBER:
434413889
ADMINISTRATOR/
DIRECTOR:		JULIE ARMENTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 466-7002
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:51 AM
MET WITH:Julie ArmentaTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Licensee Julie Armenta and explained the reason for the inspection. The purpose of this inspection is to discuss the permits on the sun room.

LPA checked the City of San Jose permit website and observed that they had applied for a permit for the sun room. Licensee stated she applied to add a bathroom to the sun room. There were children in the room at the time. Licensee stated that she will check with the City of San Jose if the sun room is permitted and submit proof to Licensing by 09/06/2024. Licensee understands that she cannot use the sun room for children until she obtains the approved permits. Licensee made the sun room off-limits during today's inspection. She will have the children play in the living room. LPA inspected the living room, which was observed to be safe for children. There is a fireplace, which is barricaded. The off-limit areas of the home are master bedroom, bedroom 2, sun room, and garage. Licensee will submit an updated LIC 999A: facility sketch by 08/31/2024.

LPA also discussed with Licensee that an updated fire clearance will need to be submitted. LPA also discussed with Licensee that if she plans on making any alternations to her home that she needs to notify Licensing prior to construction and submit an updated LIC 999A: Facility Sketch.

An updated LIC 279 and LIC 279B was obtained during today's inspection.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee Julie Armenta. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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Document Has Been Signed on 08/22/2024 05:27 PM - It Cannot Be Edited


Created By: Samantha Yip On 08/22/2024 at 10:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ARMENTA, JULIE
FACILITY NUMBER: 434413889

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
102416.3(b)

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Alterations to Existing Buildings or Grounds. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.
This requirements is not met as evidenced by:
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Deficiency corrected during today's inspection. Licensee made the sun room off-limits to children.
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Based on observation, Licensee was using the sun room, which she does not have permits for, which poses a potential health and safety risk to children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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