Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411909
Report Date: 08/31/2017
Date Signed 08/31/2017 10:05:12 AM

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:RAMIREZ, DIANAFACILITY NUMBER:
434411909
ADMINISTRATOR:RAMIREZ, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 847-8560
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 8DATE:
08/31/2017
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Diana RamirezTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced, Collateral inspection on today's date. LPA met with Diana Ramirez, Licensee, and explained the nature of today's visit. LPA explained Diana LPA was here to interview a child from a former different facility. There were eight day care children present during the inspection upon arrival.

No deficiencies were cited with today's inspection. Notice of site visit was given to Licensee and must be posted during the next 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2017
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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