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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417617
Report Date: 02/21/2023
Date Signed: 02/21/2023 09:29:14 AM

Document Has Been Signed on 02/21/2023 09:29 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:VALDES, MARIAFACILITY NUMBER:
434417617
ADMINISTRATOR:MARIA VALDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 658-3059
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/21/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria ValdesTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Teodoro Trujillo met with Applicant, Maria Valdes, on 2/21/2023 to conduct a case management visit for a Change of Location amended report. LPA was granted access to the home by the Applicant. No children were present in the home during today's visit.

LPA Trujillo provided AMENDED LIC 809-C report dated 02/14/2023 with amended statement, "This report has been amended on 2/21/2023 due to LPA oversight stating approval of small Family Child Care Home License for a change of location. The correction is, License is pending approval for a Large FCCH License by LPM".

Exit interview conducted and report was reviewed with the Applicant, Maria Valdes.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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