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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413331
Report Date: 10/23/2024
Date Signed: 10/23/2024 03:50:44 PM

Document Has Been Signed on 10/23/2024 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:WARREN, AMYFACILITY NUMBER:
444413331
ADMINISTRATOR/
DIRECTOR:		WARREN, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 219-7708
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:Amy Warren TIME VISIT/
INSPECTION COMPLETED:
03:47 PM
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Licensing Program Analyst (LPA) Elizabeth Larios met with, Licensee Amy Warren, for an unannounced annual inspection. LPA observed eleven children in the home during today's inspection and two assistant. Licensee's state they currently cares for children ages 12 months to 10 years old. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 8:00 AM to 5:30 PM. The adults and minors residing in the home is Licensee, spouse, adult children and minor child.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on July 01, 2024. Licensee states that she does have liability insurance.

LPA will resume inspection at a later time.

Exit interview conducted and report was reviewed with both Licensee, Amy Warren.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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