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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004982
Report Date: 10/18/2024
Date Signed: 10/18/2024 04:28:49 PM

Document Has Been Signed on 10/18/2024 04:28 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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:VAZQUEZ, MARIA ISABELFACILITY NUMBER:
414004982
ADMINISTRATOR/
DIRECTOR:		VAZQUEZ, MARIA ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 284-9261
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 5DATE:
10/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:50 PM
MET WITH:Licensee, Maria Isabel VazquezTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On October 18th, 2024 at approximately 3:50pm, Licensing Program Analyst (LPA), Tapia-Mandujano conducted a Case Management-Other inspection and met with licensee, Maria Isabel Vazquez. Purpose of the inspection was explained. LPA went to the home to verify that licensee is moving out of the home.

Present in the facility were licensee and assistant supervising 5 children (3 infants, and 2 preschoolers). Licensee's adult son, mom, and husband showed up while LPA was inspecting. All adults present living and/or working in the home have fingerprint clearance and are associated.

LPA inspected the home and observed that bedrooms have been cleared out. LPA observed that there are only cleaning supplies, very minimal personal belongings, and day care materials. LPA also observed that items are being loaded onto vehicles and being moved.

Per licensee, last day of operating in this home is today, October 18th, 2024 by 5pm.

LPA explained to licensee the pending items that are needed in order to license the home where she is being relocated (414005166). Licensee agrees to send items by Monday morning.

Exit interview was conducted and report was reviewed and translated into Spanish by LPA Tapia-Mandujano to licensee, Maria Isabel Vazquez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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