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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409981
Report Date: 02/22/2019
Date Signed: 10/25/2022 04:01:47 PM

Document Has Been Signed on 10/25/2022 04:01 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ENRIQUEZ, ROSAFACILITY NUMBER:
434409981
ADMINISTRATOR:ENRIQUEZ, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 848-4515
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/22/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Rosa EnriquezTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Plan of Correction visit. LPA met with Licensee Rosa Enriquez and explained the reason for the inspection. Licensee was cited on January 18, 2019 under Staffing Ratio and Capacity and Operation of a Family Child Care Home, immunization, and health and safety. Present in the home were licensee and two daycare, whom 1 was infant age. LPA observed written plan for capacity, CPR, fire drill, and immunization records for herself and children. Licensee submitted Written Plan of Correction on February 8, 2019. Deficiency under Capacity, Operation of a Family Child Care Home, and Health and Safety are hereby corrected and cleared.


As a result of this inspection, there were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2019
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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