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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417125
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:50:12 PM

Document Has Been Signed on 12/06/2023 03:50 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: 6CENSUS: 4DATE:
12/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria Vargas CamachoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Mel Matos met with Maria Vargas Camacho, Licensee, for an unannounced case management inspection. LPA was grated access to the home by the Licensee. LPA also observed four napping day care children (1 infant & 3 preschool) present in the home during today's inspection.

Licensee provided LPA with an updated Application for a Family Child Care Home (LIC 279) during today's inspection. Updated Application for a Family Child Care Home reflects the current adults, including the Licensee and her fiancé (Jonathan Correa Sanchez), residing in the home.

Licensee understands that any adult working or living in the home must obtain the required criminal record and child abuse index clearances prior to living or working in the home. Licensee also understands that she must submit an updated Application for a Family Child Care Home (LIC 279) whenever there is a change in the adult(s) residing in the home.

Exit interview conducted and report was reviewed with the Licensee, Maria Vargas Camacho. No deficiencies issued during today's inspection.

Notice of site visit issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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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