Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414668
Report Date: 01/21/2016
Date Signed: 01/21/2016 12:04:54 PM

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:HERNANDEZ, MARIA DEL PILARFACILITY NUMBER:
434414668
ADMINISTRATOR:HERNANDEZ, MARIA DEL PILARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-6266
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 3DATE:
01/21/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:MariaTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A case management visit was made to the facility. toured facility and observed 3 children in care. Today, she had one adult helper.
Maria was also giving a tour of her day care to a new family.
Reviewed facility roster which was up to date. Reviewed children's records which all were up to date.
Discussed regulation regarding fingerprints and licensee's vacation.
Notice of site visit was posted and no deficiency noted.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Roya ShahkaramiTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1