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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415616
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:26:59 PM

Document Has Been Signed on 12/20/2023 03:26 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PANAMENO, KATHERINEFACILITY NUMBER:
434415616
ADMINISTRATOR:PANAMENO, KATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 507-9595
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
12/20/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Katherine PanamenoTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mel Matos met with Katherine Panameno, Licensee, for an unannounced Required 3 year inspection. Licensee indicated to LPA that she has applied for a change of location with the San Jose Child Care District Office. Licensee states that she is in process of moving to 21869 Oakview Lane, Cupertino, CA 95014.

LPA checked the Department database and observed that the Department received Licensee's paperwork on December 13, 2023. Facility number for the new residence is: #434416865.

Licensee indicates that she has a fire inspection scheduled at the Cupertino residence for January 2, 2024. LPA advised Licensee that the Department will not conduct a prelicensing inspection until an approved fire clearance has been received.

LPA advised Licensee that Samantha Yip is the assigned LPA for her change of location request. Contact number: 408-529-8128. Email: samantha.yip@dss.ca.gov.

Exit interview conducted and report was reviewed with Katherine Panameno, Licensee, and advised her that no deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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