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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414136
Report Date: 10/04/2024
Date Signed: 10/04/2024 10:14:50 AM

Document Has Been Signed on 10/04/2024 10:14 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:GOMEZ, ALEJANDRAFACILITY NUMBER:
434414136
ADMINISTRATOR/
DIRECTOR:		GOMEZ, ALEJANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-2721
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
10/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Alejandra GomezTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Alejandra Gomez for a case management visit. LPA explained the nature of the visit. Present were licensee, licensee's assistant Melitza Luciano Verastegue and seven day care children including four infants.

Licensee is requesting to use a bathroom that was recently added to her home. A permit was obtained on 11/14/2023 in which licensee notified the Department of changes. A fire clearance was requested and clearance was granted on 09/13/2024. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA did not observe stairs or fireplace in the home. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: three bedrooms. Licensee will continue to use the bathroom located in the hallway of the home. There are no bodies of water. Backyard is fenced. Off limits outdoor: left side of home that is fenced off to children and two locked storages.

LPA informed licensee new bathroom is approved for day care use as of today. LPA reminded licensee all sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home including bathrooms must be inaccessible to children.

No deficiency was cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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