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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416851
Report Date: 11/20/2023
Date Signed: 11/20/2023 09:55:40 AM

Document Has Been Signed on 11/20/2023 09:55 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FLORES, LORNAFACILITY NUMBER:
434416851
ADMINISTRATOR:LORNA FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 518-9638
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/20/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Lorna Flores & Yi WangTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Marilou Monico, and Licensing Program Manager (LPM), Joel Segura, met with Applicant, Lorna Flores, and Applicant's adult friend, Yi "Wendy" Wang, at the San Jose Regional Office today for a scheduled Office Meeting. The purpose of today's meeting is to discuss the following:

1) Applicant's affiliation
2) Daycare payment
3) Compliance and ability to follow Title 22 Regulations

Applicant understands that:
1) Family Child Care Home License is issued to individual/s and non-transferable.
2) Daycare payment will be made out to her account.
3) She will reside in the home to be licensed.
4) She will stay current and in compliance with laws and regulations governing standards for Family Child Care Homes.
5) She will be forthcoming to Community Care Licensing (CCL) staff.

LPM Joel Segura explained to Applicant that if there are issues noted on this report that will result in regulatory violations, the Facility may be referred to legal department for possible administrative action.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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