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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414297
Report Date: 08/08/2024
Date Signed: 08/08/2024 02:29:25 PM

Document Has Been Signed on 08/08/2024 02:29 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:JOHNSON, CHRISTINAFACILITY NUMBER:
434414297
ADMINISTRATOR/
DIRECTOR:		JOHNSON, CHRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 413-9272
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
08/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Johnson, ChristinaTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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On 8/8/2024, at 2:25 PM, Licensing Program Analyst (LPA) Doni Fici arrived to conduct a case management visit to deliver amended reports dated for 6/28/2024. LPA was greeted by Licensee, Johnson, Christina and explained the purpose of the visit.

LPA obtained the original reports dated for 6/28/2024 and delivered amended reports today, dated for 8/8/2024.

No deficiencies cited during visit.

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


Exit interview conducted with Licensee, and this report reviewed and provided along with appeal rights.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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