<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415535
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:57:29 PM

Document Has Been Signed on 10/05/2023 03:57 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BANUELOS, YADIRAFACILITY NUMBER:
434415535
ADMINISTRATOR:YADIRA BANUELOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 286-8714
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Yadira BanuelosTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA Mel Matos met with Yadira Banuelos, Licensee, for an unannounced case management inspection. LPA also observed two adult assistants (Iris Martinez & Francisca "Lucy" Castaneda ) and eleven day care children (8 preschool & 3 infant) in the home during today's inspection.

LPA also discussed the safe sleep regulations with the Licensee and reminded her that infants cannot be swaddled while in care and that there shall be no objects hanging above or attached to the sides of a crib or play yard, regardless if the child's parent(s)/guardian(s) give authorization.

LPA referred the Licensee to Section 102425 - Infant Safe Sleep - of Title 22 regulations for additional information regarding Infant Safe Sleep.

Exit interview conducted and report was reviewed with the Licensee, Yadira Banuelos. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1