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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417125
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:39:57 PM

Document Has Been Signed on 04/18/2024 03:39 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VARGAS CAMACHO, MARIAFACILITY NUMBER:
434417125
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Maria Vargas CamachoTIME VISIT/
INSPECTION COMPLETED:
04:00 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 three day care children (1 infant & 2 preschool) and one adult assistant (Veronica Vallejo Camacho) present in the home during today's inspection.

LPA reviewed one staff file (Veronica Vallejo Camacho) and observed a complete file, including CPR/First Aid certifications (exp 01/03/2026), Mandated Reporter Training for Child Care Workers, and current immunization current.

An updated Application for a Family Child Care Home License (LIC 279) was provided to LPA during today's inspection.

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: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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