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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416004
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:49:14 PM

Document Has Been Signed on 03/14/2024 02:49 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:CASILLAS, MARIAN & SANDOVAL, JUANFACILITY NUMBER:
434416004
ADMINISTRATOR:MARIAN CASILLAS & JUAN SANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 771-1463
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 8DATE:
03/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Marian CasillasTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Marian Casillas for a Plan of Correction visit. LPA explained the nature of the visit. Presente were licensee Maria Casillas, her two assistants and eight day care children including three infants.

Licensee failed to correct citations issued on 03/04/2024. Licensee failed to submit a statement stating she understands she may not use of off limit bedrooms for day care use, a statement stating she understands children must sleep in safe equipment and failed to submit immunization records for five children. LPA reviewed files and observed files were not updated with immunization records. Licensee printed out the immunization records for four children but is still missing updated immunization records for child 1. LPA observed LIC9224 in children's files and required postings for report conducted on 03/04/2024.

No deficiency was cited.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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