<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416530
Report Date: 10/03/2022
Date Signed: 10/03/2022 12:20:02 PM

Document Has Been Signed on 10/03/2022 12:20 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MOHAMED YOUSUF, PARVIN BANUFACILITY NUMBER:
434416530
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
10/03/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Parvin Banu Mohamed YousufTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 3rd,2022 at 12pm, Licensing Program Analyst (LPA) Kassandra Medrano met with applicant,Parvin Banu Mohamed Yousuf for an announced subsequent pre-licensing inspection. Applicant lives in a single family home, with Licensee and her husband. Home has 3 bedrooms and 2 bathrooms. Hours of operation will be 9am-6pm, Monday-Friday. CHILD CARE AREA: Bedroom #1, Bathroom#1, Living room, and Backyard. OFF LIMIT AREAS: Bedroom #2, Bedroom #3, Bathroom #2, Kitchen, Garage, Front yard. LPA inspected the entire home with the applicant for health and safety hazards. During todays inspection, LPA observed that applicant has moved into home. LPA observed that applicant has made the corrections needed. Child care areas have been set up for care, and required postings have been posted.

The facility will be recommended for licensure, as of tomorrow 10/04/2022, as the applicant is still operating at previous location.

Exit interview conducted and report was reviewed with the Applicant, Parvin Banu.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1