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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417718
Report Date: 01/16/2024
Date Signed: 01/16/2024 03:45:05 PM

Document Has Been Signed on 01/16/2024 03:45 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:GONZALEZ, ERICAFACILITY NUMBER:
434417718
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 1DATE:
01/16/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Erica GonzalezTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Erica Gonzalez for a case management visit. Licensee is requesting to add a room for day care use. Present were licensee, licensee's adult daughter, 10 year old daughter and one day care infant.

The room left of the kitchen was toured and is adequate, safe and has sufficient toys. Off limits room in the home are two bedroom, laundry room and bathroom that is near the laundry room. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA all proper postings. LPA informed licensee room is approved effective today.

No deficiency was cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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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