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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415413
Report Date: 12/20/2024
Date Signed: 12/20/2024 09:25:34 AM

Document Has Been Signed on 12/20/2024 09:25 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:FURTADO, ANAFACILITY NUMBER:
434415413
ADMINISTRATOR/
DIRECTOR:		ANA FURTADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 826-2179
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ana FurtadoTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennifer "Jen" Beehler and Darnella Barnes conducted an unannounced case management visit. Upon arrival, LPAs were greeted by the licensee at the main house. Licensee stated that she had no kids in care today. LPAs stated the purpose of today's visit was to discuss the room attached to the backside of the garage.

LPAs stated a fire clearance was required in order for a large family home location to change. Licensee stated she would move the day care back into the home while the fire clearance was conducted. Licensee stated the day care room had been there for many years and did not know if it was classified as living space. LPAs stated city planning could assist licensee with answering these questions and converting it from storage to living space if that was required. LPAs did warn licensee if the fire clearance did not pass for the large day care room on the back of the garage, the day care could not continue in there until all items were passed and approved and fire clearance received.

LPAs will submit the fire clearance request per the permission of the licensee.

During today's visit, LPAs observed the license number of the day care was missing on two signs in the front yard advertising the day care. Licensee stated the number she attached at the last visit fell off during the storm. During the inspection, Licensee wrote the license number in purple market so that it was permanently adhered.

Due to today's inspection, one Type B citation was issued. This is the second deficiency of the same requirement in the past 12 months which will result in a civil penalty of $100. Exit interview conducted with licensee, Ana Furtado. Report reviewed and provided along with Appeal Rights.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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