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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416728
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:57:43 PM

Document Has Been Signed on 09/13/2023 03:57 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:KASSEL, ALEXANDRIAFACILITY NUMBER:
434416728
ADMINISTRATOR:ALEXANDRIA KASSELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 427-2819
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
09/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Alexandria KasselTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted a Plan of Correction (POC) inspection. LPA met with Licensee Alexandria Kassel and explained the reason for the inspection. The purpose of this inspection is Licensee was cited on 09/07/2023 for not having the in-ground pool and hot tub fenced. Licensee submitted proof to Licensing on 09/08/2023 that fence was placed back.

During today's inspection, LPA inspected the pool and hot tub. The pool and hot tub is fenced and the gate leading to the pool is locked.

No deficiencies were issued as result of this inspection. Exit interview conducted and report was reviewed with Licensee Alexandria Kassel. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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