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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415104
Report Date: 11/01/2022
Date Signed: 11/03/2022 10:55:45 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/03/2022 10:55 AM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:OUYANG, ANNFACILITY NUMBER:
434415104
ADMINISTRATOR:OUYANG, ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 893-2336
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Ouyang,AnnTIME COMPLETED:
12:39 PM
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On November 1 , 2022 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual random inspection of the home. LPA met with Licensee Ann Ouyang, and explained the purpose of today's inspection. There were 0 children present.

Licensee states she has not had children in care for the last 2 years. Licensee states she is no longer interested in maintaining day care license for personal reasons. Licensee submitted her License and a copy of Certification Non-Operation signed 10/31/2022.



SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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