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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416762
Report Date: 03/06/2025
Date Signed: 03/06/2025 09:52:52 AM

Document Has Been Signed on 03/06/2025 09:52 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:ORTEGA, ANA KARINAFACILITY NUMBER:
434416762
ADMINISTRATOR/
DIRECTOR:		ORTEGA, ANA KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 843-8923
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 28CENSUS: 11DATE:
03/06/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ortega, Ana KarinaTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On the above date, Licensing Program Analyst (LPA), Liridon Fici- Doni conducted an unannounced Plan of Correction (POC) visit, and was greeted by licensee, Ortega, Ana Karina, and explained the purpose of today’s visit. LPA observed one (1) infant, seven (7) preschoolers, and three (3) school age children present in the home along with three (3) staff members. All staff present are fingerprint cleared and associated to the facility.

The purpose of the POC visit is to verify corrections of the deficiency that was previously cited on 2/20/2025 for a Type B deficiency.

Upon arrival to the day care, LPA observed the ratio and capacity of the home is in-compliant to Title-22 and is meeting the regulation for section 102416.5- Staffing Ratio and Capacity.

LPA observed the following deficiency, cited on 2/20/2025, was corrected and have been cleared.

A NOTICE OF SITE VISIT WAS ISSUED TODAY AND MUST REMAIN POSTED ALONG WITH PROOF OF CORRECTED DEFICIENCIES FOR 30 days.

Exit interview conducted with Licensee, and a copy of this report reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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