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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416757
Report Date: 02/08/2022
Date Signed: 02/08/2022 03:21:42 PM

Document Has Been Signed on 02/08/2022 03:21 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:ANJALI, FNUFACILITY NUMBER:
434416757
ADMINISTRATOR:FNU, ANJALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 650-2406
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Fnu AnjaliTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Marilou Monico, and Licensing Program Manager (LPM), Joel Segura, met with Applicant, Fnu Anjali, at the San Jose Regional Office today for a scheduled Office Meeting. The purpose of today's meeting is to discuss the following:

1) Applicant's affiliation
2) Control of Property
3) Daycare payment
4) Compliance and ability to follow Title 22 Regulations

Applicant states that:
1) She is not affiliated to any other daycare/business.
2) She is leasing the home from the owner, Vibhesh Patel.
3) Daycare payment will be made out to her account.

Applicant understands that:
1) She will reside in the home to be licensed.
2) She will stay current and in compliance with laws and regulations governing standards for Family Child Care Homes.
3) She will be forthcoming to Community Care Licensing (CCL) staff.

LPM Joel Segura explained to Applicant that if there are continued issues noted on this report, the Facility may be referred to legal department for possible administrative action.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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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