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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417630
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:02:11 PM

Document Has Been Signed on 09/06/2023 04:02 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:LOZANO, BRIANNAFACILITY NUMBER:
274417630
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Brianna LozanoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with licensee Brianna Lozano. LPA observed that licensee's two years old child was present. Licensee also was providing care to four children, included one infant her own preschool age and two more preschool age children. LPA reviewed on licensee's files and verified licensee is not missing any forms. Licensee is doing all paper work required including the safe sleep regulations. Licensee has a current children roster and licensee has documented also a fire drill on 6/27/23.

No deficiencies were cited today.

A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive days.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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