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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417941
Report Date: 09/25/2026
Date Signed: 09/25/2026 02:50:37 PM

Document Has Been Signed on 09/25/2026 02:50 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VAZQUEZ REGALADO, IVONNFACILITY NUMBER:
434417941
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/25/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:19 PM
MET WITH:Ivonn Vazquez RegaladoTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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******************This inspection was conducted in Spanish***********************

Licensing Program Analyst Diana De Leon met with licensee Ivonn Vazquez Regalado for an unannounced case management visit. LPA explained the nature of the visit. Present were licensee and three day care children – two preschoolers and one infant.

During the visit, the Licensee disclosed that on 09/16/2026 an infant was enrolled and admitted into care without any of the required admission documents on file. The Licensee stated that the parents were expected to provide the forms later in the week and that care for the infant commenced prior to receiving the required documentation. LPA advised the Licensee of the potential health, safety, and liability risks associated with admitting an infant into care without maintaining the mandated records. LPA reminded the Licensee that all required forms must be completed and available prior to enrollment to ensure compliance with Title 22 regulations and to safeguard children in care.

Based on observation and interview, the Licensee did not have the required admission documentation on file for an infant who was enrolled on 09/16/2026. This poses a potential health, safety, and personal rights risk to children in care.

The following type B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

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Susy Cervantes
Diana De Leon
DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: VAZQUEZ REGALADO, IVONN
FACILITY NUMBER: 434417941
VISIT DATE: 09/25/2026
NARRATIVE
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Report was reviewed and appeal rights were given to licensee Ivonn Vazquez Regalado.

Notice of site visit must remain posted on, or immediately adjacent to, the interior side of the main entrance door for 30 consecutive days.

Failure to maintain the Notice of Site Visit as required may result in civil penalties.







END OF REPORT
















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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Diana De Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/25/2026 02:50 PM - It Cannot Be Edited


Created By: Diana De Leon On 09/25/2026 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VAZQUEZ REGALADO, IVONN
FACILITY NUMBER: 434417941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2026
Section Cited
CCR
102418(g)

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Immunizations : (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by: Licensee did not have the required admission documentation on file for an infant who was enrolled on 09/16/2026
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Licensee will submit a statement stating she understands the regulation to CCLD. In addition watch the videos on our website for child care providers regarding record keeping : https://ccld.childcarevideos.org/family-child-care-providers/ by POC date 10/09/2026.
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This poses a potencial risk to the Health, Safety or Personal Rights to children in care.
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Type B
10/09/2026
Section Cited
CCR102419(d)

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Admission Procedures and Parental and Authorized Representative's Rights : (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by: Licensee did not have the required admission documentation on file for an infant who was enrolled on 09/16/2026
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Licensee will submit a statement stating she understands the regulation to CCLD. In addition watch the videos on our website for child care providers regarding record keeping : https://ccld.childcarevideos.org/family-child-care-providers/ by POC date 10/09/2026.
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This poses a potencial risk to the Health, Safety or Personal Rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susy Cervantes
NAME OF LICENSING PROGRAM MANAGER:
Diana De Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/25/2026 02:50 PM - It Cannot Be Edited


Created By: Diana De Leon On 09/25/2026 at 02:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VAZQUEZ REGALADO, IVONN
FACILITY NUMBER: 434417941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2026
Section Cited
CCR
102421(b)

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Child's Records : (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by: Licensee did not have the required admission documentation on file for an infant who was enrolled on 09/16/2026

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Licensee will submit a statement stating she understands the regulation to CCLD. In addition watch the videos on our website for child care providers regarding record keeping : https://ccld.childcarevideos.org/family-child-care-providers/ by POC date 10/09/2026.
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This poses a potencial risk to the Health, Safety or Personal Rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susy Cervantes
NAME OF LICENSING PROGRAM MANAGER:
Diana De Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2026


LIC809 (FAS) - (06/04)
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