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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411861
Report Date: 09/28/2021
Date Signed: 09/28/2021 04:12:46 PM

Document Has Been Signed on 09/28/2021 04:12 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:SANTOS, YAMILEFACILITY NUMBER:
434411861
ADMINISTRATOR:SANTOS, YAMILEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 766-9448
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
09/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Yamile SantosTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with licensee Yamile Santos on a Case Management inspection. A current resident of the home, Lourdes Morales, has applied for a Family Child Care Home (FCCH) license and LPA will inspect the home on a pre licensing inspection. Licensee Yamile understands that only one license can be active in the same home address at the time. Licensee Yamile has submitted a postdated (9/30/21) letter where she surrenders her FCCH license. LPA observed licensee was providing care to seven children included five preschool age and two infants.

No deficiencies were cited today.

Notice of site visit was issued and must be posted for the following days and until a new license arrives for the current resident Lourdes Morales.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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