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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415413
Report Date: 02/25/2025
Date Signed: 02/25/2025 02:57:38 PM

Document Has Been Signed on 02/25/2025 02:57 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: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: 6DATE:
02/25/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Ana FurtadoTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced case management inspection to review the licensing area change. Upon arrival, LPA was greeted by the licensee and provided access to the facility.

LPA observed an outdoor classroom in the back of the yard that had a permanent structure over head and side plastic walls to keep the elements out. Children were observed to be playing with age appropriate toys. LPA observed a second area under the back of the house where a porch has been enclosed with plastic curtains to keep the elements out. LPA observed an empty hot tub with a hard locked cover that you could stand on. It was being used as a shelf with children's toys in bins stored on top of it. It was not accessible to the children. LPA observed named totes for children's art, age appropriate toys and a table for food service.

LPA reviewed the route to the bathroom during the inspection. Children will enter the home through the side yard, walk through the kitchen to the hall bathroom. These areas have all received fire clearance. LPA observed cleaning products on the floor. Licensee immediately placed it in an area out of reach of children.

Due to today's visit, one type b deficiency was cited, more information on the attached LIC-809D. Exit interview conducted, report reviewed and provided along with appeal rights. NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 02/25/2025 02:57 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 02/25/2025 at 02:40 PM
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: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (4)Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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Licensee placed hazardaous items in an inaccessible location during today's visit.
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This requirement has not been met as evidenced by: LPA observed cleaning wipes and bleach detergent on the floor in hall and kitchen which is accessible to children in care. This poses a potential health and safety risk to children in care.
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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