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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416045
Report Date: 02/10/2022
Date Signed: 02/10/2022 11:13:31 AM

Document Has Been Signed on 02/10/2022 11:13 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:RUIZ TORRES, EVELYNFACILITY NUMBER:
434416045
ADMINISTRATOR:EVELYN RUIZ TORRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 716-7318
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/10/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Evelyn Ruiz TorresTIME COMPLETED:
11:30 AM
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On 02/10/2022 at 10:05 AM, Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Susy Cervantes, met with applicant, Evelyn Ruiz Torres, for an office visit in regards to their application for a large Family Child Care home (FCCH).
LPM Segura explained to applicant that in order to qualify for a large FCCH they must have one year experience as a small FCCH or have experience as a teacher or director at a licensed child care center. Experience at a licensed FCCH, that is not applicants, does not qualify as teacher experience. Applicant will re-take the orientation and will review Title 22 regulations within 30 days (Friday 03/11/2022 will be 29 days). Applicant will take an exam to show Title 22 comprehension and will submit orientation certificate. After completion, applicant will submit new application for a small FCCH. After one year experience and if facility is in substantial compliance, applicant can submit application for a large FCCH.

Exit interview conducted and report was reviewed with the applicant, Evelyn Ruiz Torres.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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