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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416318
Report Date: 01/24/2025
Date Signed: 01/26/2025 11:48:44 PM

Document Has Been Signed on 01/26/2025 11:48 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:REY, YELENAFACILITY NUMBER:
434416318
ADMINISTRATOR/
DIRECTOR:
REY, YELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 245-1821
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/24/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Yelena ReyTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst(LPA) Anna Morales conducted a Case Management inspection and was met by Licensee Yelena Rey. Licensee has submitted a request to CCL(Community Care Licensing) to place License back into Active Status. The facility hours are 7:30am- 5pm, ages 2-5 years of age
Licensee stated that she is only adult that resides at the facility.
Licensee has a current Pediatric First Aid/CPR(expires on 5/11/26), and her
Mandated Reporter Training (expires on 12/12/2025).

Licensee, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

LPA toured the facility with Licensee. LPA observed that there were no wall heaters. LPA observed the home has working smoke/carbon monoxide detectors, pull fire alarm and fire extinguisher. Observed the activity rooms with appropriate table and chairs and age appropriate activities. LPA observed cots and mats. LPA observed a secured fenced playground. Age appropriate play structure is equipped with resilient material. No bodies of water observed. Observed a first aid kit. Licensee stated that there are no firearms in the home. All of the toxic materials and sharp objects are stored and inaccessible to children.

Exit interview was conducted with Licensee and No deficiencies were cited. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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