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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434417362
Report Date:
10/11/2023
Date Signed:
10/11/2023 12:09:43 PM
Document Has Been Signed on
10/11/2023 12:09 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
SAN JOSE CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
VALDEZ, VANESSA G.
FACILITY NUMBER:
434417362
ADMINISTRATOR:
VALDEZ, VANESSA G.
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 963-8169
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95118
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
10/11/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA's) Anna Morales and Mel Matos conducted a scheduled Case Management Visit The purpose for this inspection is to inspect the backyard and the swimming pool area. LPA Morales was notified by the Applicant Vanessa Valdez that she would be unavailable due to an Emergency and gave approval for the LPA's to enter the backyard to conduct the inspection without her present.
The Amended report was for the Pre- Licensing visit conducted on 9/13/23 by LPA Anna Morales.
A signature from the APPLICANT could not be obtain as she was not present at the visit. LPA Morales informed her that she would send her copy of the report(s) electronically and leave copies in a secured location at the day care.
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Anna Morales
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2023
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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