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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
444417782
Report Date:
09/05/2024
Date Signed:
09/05/2024 10:22:44 AM
Document Has Been Signed on
09/05/2024 10:22 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
SAN JOSE CC RO
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
ESCOBAR, MARIA
FACILITY NUMBER:
444417782
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
7
CENSUS:
6
DATE:
09/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:
Maria Escobar
TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with licensee Maria Escobar. Licensee was providing care to six children today including one infant and five preschoolers. LPA reviewed children's roster and 6 children's files and verified licensee is not missing any forms. Licensee is in compliance with the safe sleep regulations paperwork. Licensee stated she started working with children on 5/29/24. Licensee has documented also a fire drill on 8/13/24. Technical advise was provided to licensee on the use of form Lic9166
No deficiencies were cited today.
A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive days.
SUPERVISORS NAME
:
Susy Cervantes
LICENSING EVALUATOR NAME
:
Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/05/2024
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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