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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416757
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:13:31 PM

Document Has Been Signed on 11/04/2022 03:13 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:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
11/04/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Fnu AnjaliTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Marilou Monico met with Licensee, Fnu Anjali, for a Plan of Correction Inspection. The facility was cited on November 2, 2022 under Staffing Ratio and Capacity.

During today's inspection, LPA observed the following:
1) Four (4) children including three (3) infants and one (1) preschool age present in the home.
2) Notice of Site Visit and Licensing report were posted on the board near the front door.
2) Five (5) completed and signed Acknowledgement of Receipt of Licensing Reports (LIC 9224).

Deficiency on Staffing Ratio and Capacity, is hereby corrected and cleared.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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