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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434416752
Report Date:
04/19/2023
Date Signed:
04/19/2023 02:21:46 PM
Document Has Been Signed on
04/19/2023 02:21 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:
MALDONADO, LAURA
FACILITY NUMBER:
434416752
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
6
DATE:
04/19/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
01:56 PM
MET WITH:
Maldonado, Laura
TIME COMPLETED:
02:21 PM
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LPA Teodoro Trujillo met with licensee Laura Maldonado for a Plan of Correction inspection. LPA explained the nature of today's inspection to Licensee. LPA observed six children: three infants and three pre-school age with Licensee. The family child care home is within ratio and capacity today.
LPA Trujillo conducted an annual/change of capacity inspection on 03/29/2023 at the facility. Fire clearance was approved. Deficiencies were cited; and all corrections were made. Deficiencies were cleared.
No deficiency was cited. Notice of visit was issued and must be posted for 30 days.
SUPERVISORS NAME
:
Mary Segura
LICENSING EVALUATOR NAME
:
Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/19/2023
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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