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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415579
Report Date: 11/19/2021
Date Signed: 01/04/2024 10:15:50 AM

Document Has Been Signed on 01/04/2024 10:15 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:GARCIA CONTRERAS, LOURDESFACILITY NUMBER:
434415579
ADMINISTRATOR:LOURDES GARCIA CONTRERASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 583-7871
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/19/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Lourdes Garcia ConterasTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with licensee, Lourdes Garcia Contreras for a Plan of Correction visit. LPA explained the nature of the visit. Present were licensee, and six day care children.

LPA toured the inside and outside of the home to ensure compliance. Licensee was cited on 11/16/2021. LPA observed 15 minute sleep checks for infants, Individual sleeping plan (LIC9227), LPA received written plans of corrections.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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