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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430757125
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:08:36 PM

Document Has Been Signed on 05/25/2023 02:08 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CRUZ, GUADALUPEFACILITY NUMBER:
430757125
ADMINISTRATOR:CRUZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 225-2941
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Guadalupe CruzTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Joe Macias conducted an unannounced Case Management Inspection. The LPA was greeted and granted entrance by the Licensee Guadalupe Cruz. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Todays census is 4, (2 infants, 2 preschool age). The hours of operation are Monday - Friday, 6am - 6pm.


During today's inspection LPA Macias issued an amended report for an inspection conducted on March 29, 2023.


Exit interview conducted, amended report issued, and a copy of this report was provided to the Licensee Guadalupe Cruz.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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