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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416445
Report Date: 03/19/2025
Date Signed: 03/19/2025 11:05:50 AM

Document Has Been Signed on 03/19/2025 11:05 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:RIVERA, TABITHAFACILITY NUMBER:
434416445
ADMINISTRATOR/
DIRECTOR:		TABITHA RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 718-0230
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
03/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Tabitha RiveraTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Case Management inspection. The purpose of today's inspection was to discuss the incident that occurred on 03/11/2025. LPA was greeted by Facility Representative, Kristen Simas-Gallis and provided access to the property.

LPA observed 8 preschool-age children, 4 toddler-age children and 1 infant with 4 qualified adults which is compliant with ratio requirements and capacity.

LPA reviewed the incident with the licensee and Facility Representative, Kristen Simas-Gallis.

Due to today's inspection, no deficiencies were cited. Exit interview conducted with Facility Representative Kristen Simas-Gallis.

NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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