<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408224
Report Date: 12/06/2022
Date Signed: 12/06/2022 02:58:24 PM

Document Has Been Signed on 12/06/2022 02:58 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:BAXTER, MICHELLEFACILITY NUMBER:
434408224
ADMINISTRATOR:BAXTER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 842-8004
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Michelle BaxterTIME COMPLETED:
10:10 AM
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
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1 Year inspection. LPA met with Licensee Michelle Baxter and explained the reason for the inspection. There were no daycare children present during today's inspection. Licensee stated that her family child care home is currently temporary closed.

During today's inspection, Licensee filled out the LIC 9211: Request for Inactive Status and provided to it to LPA. LPA informed Licensee the conditions of the inactive status. LPA also informed her that an updated license will be mailed to her to reflect the inactive status.


As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Licensee Michelle Baxter. A notice of site was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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