<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274417692
Report Date:
04/04/2024
Date Signed:
04/04/2024 11:19:11 AM
Document Has Been Signed on
04/04/2024 11:19 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 CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
RAMIREZ, ADRIANA
FACILITY NUMBER:
274417692
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
2
DATE:
04/04/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:
Adriana Ramirez
TIME VISIT/
INSPECTION COMPLETED:
11:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with licensee Adriana Ramirez. LPA observed that licensee's Mother Lilia was present. Licensee also was providing care to two preschool age children. LPA reviewed on licensee's files and verified licensee is not missing any forms. Licensee was advised to conduct and document a fire/disaster drill at least every six months.
No deficiencies were cited today.
A notice of Site inspection was printed and licensee was instructed to post it visible to the children's parents for 30 days.
SUPERVISORS NAME
:
Susy Cervantes
LICENSING EVALUATOR NAME
:
Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/04/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1