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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416517
Report Date: 06/24/2022
Date Signed: 06/24/2022 12:18:22 PM

Document Has Been Signed on 06/24/2022 12:18 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUERRERO INFANTE, NORA & QUINTANA MORALES, ARTUROFACILITY NUMBER:
434416517
ADMINISTRATOR:NORA & ARTUROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 394-8302
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/24/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Nora Guerrero InfanteTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced prelicensing inspection and met with Nora Guerrero Infant, co-Applicant. LPA did not observe any children in the home during today's inspection.

LPA advised Nora that she does not currently have an active association (re: criminal record & child abuse index clearances) to process her transfer request to her existing facility number.

LPA advised Nora that she needs to submit a new background check in order to have an active association of her clearances.

LPA provided a Request for LiveScan Service (LIC 9163) to the Applicant and advised her to submit a copy to LPA once she has gotten fingerprinted.

LPA advised Nora that a prelicensing inspection will be scheduled once her clearances are associated to her existing facility number.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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