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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434402958
Report Date: 01/06/2025
Date Signed: 01/07/2025 03:22:30 PM

Document Has Been Signed on 01/07/2025 03:22 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:ANAYA-BUENO, JOHANNAFACILITY NUMBER:
434402958
ADMINISTRATOR/
DIRECTOR:		ANAYA, JOHANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 506-4977
CITY:SAN JOSESTATE: CAZIP CODE:
95110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
01/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:12 PM
MET WITH:Johanna, Anaya-BuenoTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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On 1/7/2025 at 3:12 PM, Licensing Program Analyst (LPA) Liridon Fici-Doni arrived unannounced to conduct a case management visit to deliver amended report dated for 11/1/2024. LPA was greeted by Licensee, Johanna, Anaya-Bueno and explained the purpose of the visit.

LPA obtained the original report dated for 11/1/2024 and delivered amended report today, dated for 1/7/2025.

No deficiencies cited during visit.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted with Licensee, and this report reviewed and provided.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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