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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404978
Report Date: 04/19/2021
Date Signed: 04/19/2021 09:41:39 AM

Document Has Been Signed on 04/19/2021 09:41 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LOS ARROYOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404978
ADMINISTRATOR:OKSANA OKSFACILITY TYPE:
850
ADDRESS:885 MORO DRIVETELEPHONE:
(408) 843-9005
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 104TOTAL ENROLLED CHILDREN: 0CENSUS: 32DATE:
04/19/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Oksana OksTIME COMPLETED:
09:31 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced Case Management- Other inspection. Due to COVID-19 and shelter in place, a tele-inspection was conducted via Facetime. LPA met with Site Director Oksana Oks and explained the reason for the inspection. LPA informed Site Director that a copy of this report will be emailed to her. Site Director's response to email will serve as acknowledgement that report was received.

The purpose of this inspection is to discuss the amended 809 reported dated 04/08/2021 page 2. There are 14 sinks inside the facility and three additional sinks in the yard for the children to use. A copy of the amended report dated 04/08/2021 was emailed to Site Director.

No deficiencies have been cited as a result of this inspection. An exit interview was conducted where this report was discussed and email to Site Director Oksana Oks. A Notice of Site Visit has been issued and must be posted for 30 days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2021
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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