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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417125
Report Date: 08/09/2023
Date Signed: 08/09/2023 02:14:53 PM

Document Has Been Signed on 08/09/2023 02:14 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:VARGAS CAMACHO, MARIAFACILITY NUMBER:
434417125
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Maria Vargas CamachoTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) met with Maria Vargas Camacho, Applicant, to conduct an announced follow up prelicensing inspection at 526 East Evelyn Avenue, Sunnyvale CA 94086. The initial prelicensing inspection was completed on August 2, 2023 and the Applicant was advised that a small Family Child Care Home license would be approved upon completion of the following:

1) Updated Facility sketch reflecting the correct off limit and day care use space has been submitted.
2) Padding has been installed underneath and surrounding the two slides in the play structure in the backyard.
3) The space/gap between the concrete step and gate area leading to the outdoor basement entrance needs to be sealed off to make the area off limits.

Applicant provided LPA with an updated Facility sketch reflecting the correct off limit and day care use space of the home (off limit space noted on previous reported dated August 2, 2023.

Applicant installed padding underneath and surrounding the two slides of the play structure in the backyard.

The space/gap between the concrete step and gate area leading to the outdoor basement entrance has been sealed off to make the area off limits.

Exit interview conducted and report was reviewed with the Applicant, Maria Vargas Camacho. LPA advised the Applicant that a small Family Child Care Home license is approved as of today, August 9, 2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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