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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416385
Report Date: 09/22/2023
Date Signed: 09/22/2023 10:14:32 AM

Document Has Been Signed on 09/22/2023 10:14 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GOMEZ, LISETTE & MARISOLFACILITY NUMBER:
434416385
ADMINISTRATOR:GOMEZ, LISETTE & MARISOLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 603-5063
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
09/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Marisol & Lisette GomezTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Ashley conducted a Case Management Inspection in response to an alleged incident that was self-reported by Licensee to Community Care Licensing (CCL) on 9/5/23. LPA met with the Licensees Marisol and Lisette Gomez and explained the purpose of today's visit. 9 children were present at the facility today during today’s visit.

The Unusual Incident Report that was reported by the licensee involves a child (C1) that stated his personal rights were violated while attending the family child care home. The licensee reported the accusation to the child’s mother that day at pick up time. LPA conducted interviews pertinent to this case management inspection and observed children and staff. LPA discussed with the licensees about the incident in further detail and the action taken following the incident. As a result of the incident, C1 no longer attends the family childcare home. Based on interviews and evidence gathered, there is no preponderance of evidence to prove that staff violated the child's personal rights.

As a result of the case management, no deficiencies were cited.

Exit interview conducted and report was reviewed with licensees, Marisol and Lisette Gomez. A copy of this report and appeals right were provided to the licensees.

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: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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