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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416865
Report Date: 01/17/2024
Date Signed: 01/18/2024 02:43:12 PM

Document Has Been Signed on 01/18/2024 02:43 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:
434416865
ADMINISTRATOR:KATHERINE PANAMENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 507-9595
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
01/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Katherine PanamenoTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Licensee Katherine Panameno and explained the reason for the inspection. The purpose of this inspection is to make the backyard on-limits and to check the fence. Upon arrival, LPA observed that there were six children in the backyard, whom 5 were her own children. LPA discussed with Licensee that her backyard was listed as off-limits due to her fence not being fixed. Licensee stated that she understand during the pre-licensing inspection that she could not use the backyard until fence was fixed and Licensing came to check it. Licensee had the children go inside.

LPA inspected the fence. LPA observed that the rights side of the fence is not leaning over. There is still a gap where there is a tree that is on her property leans into the neighbor's. Licensee understands that she needs to put a gate to cover the gap until the fence is fixed. LPA also observed that there were two other gaps in the back fence. Licensee stated that she will send a picture to Licensing.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Licensee Katherine Panameno. A notice of site visit has been issued.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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