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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415413
Report Date: 12/03/2024
Date Signed: 12/03/2024 09:41:39 AM

Document Has Been Signed on 12/03/2024 09:41 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: DATE:
12/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ana FurtadoTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced plan of correction visit to inspect items addressed in the report from 11/12/2024. LPA was greeted by the licensee and provided access to the property. LPA stated the reason for the visit was to review that the plan of correction has been completed.

Upon arrival at the property, LPA observed an A-frame sign advertising the day care. The license number was not posted on this sign. LPA had mentioned this to licensee during the last visit and stated she should remove the sign until she has placed the license number on it. Licensee did not comply.

LPA observed the area with rusted and sharp tools to be cleared out. LPA observed 10 preschool age children in care with one assistant, which is compliant with the license and ratio requirements.

LPA observed the notice of site visit was not posted from the annual inspection on 11/12/2024. LPA mentioned this to licensee and she pulled out the notice and posted it near the entrance.

LPA discussed the changes within the day care, as the location has changed from the main house to the large room behind the garage which was part of the existing garage structure. Licensee provided an updated LIC279, LIC610A and LIC999 showing the changes for the day care location. LPA will bring this back to the department and discuss with management next steps.

During today's inspection two Type B citations were issued and one civil penalty. More information provided on the attached LIC809-D and the LIC421CC. Exit interview completed with licensee, Ana Furtado, report reviewed and provided along with appeal rights.

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: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 12/03/2024 09:41 AM - It Cannot Be Edited


Created By: Jennifer Beehler On 12/03/2024 at 08:53 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: FURTADO, ANA
FACILITY NUMBER: 434415413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2024
Section Cited
CCR
102359(a)(1)(A-F)

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Advertisement and License Number: Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. (1) Advertisements, publications, or announcements subject to the requirements of Section 102359(a) include, but are not limited to, those contained in the following:
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 Licensee cleared the citation during today's inspection by taping the license number to the sign.
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(A) Newspaper or magazine. (B) Consumer report. (C) Announcement of intent to commence business. (D) Telephone directory yellow pages. (E) Professional or service directory.(F) Radio or television commercial.

This requirement has not been met as evidenced by: A-Line sign advertising day care in the front of the property does not have the license number.
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Type B
12/03/2024
Section Cited
HSC1596.817(b)(1)(2)

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Site Visits: (b)(1) The notice posted pursuant to subdivision (a) shall remain posted for 30 consecutive days, except that a family day care home shall comply with the posting requirements contained in this subdivision only during the hours when clients are present.
(2) Failure by a licensed child day care facility or a family day care home to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).
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Licensee posted the Notice of Site visit during today's inspection. Licensee stated she would post today's Notice of Site visit today.
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This has not met as evidenced by: LPA observed the Notice of Site Visit was not posted from the 11/12/2024 inspection.
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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:Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


LIC809 (FAS) - (06/04)
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