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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412831
Report Date: 10/18/2022
Date Signed: 10/18/2022 09:24:14 AM


Document Has Been Signed on 10/18/2022 09:24 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GUERRERO, CORINAFACILITY NUMBER:
013412831
ADMINISTRATOR:GUERRERO, CORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 728-1027
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:14CENSUS: 4DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Corina GuerreroTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst Sidney Cortez met with licensee Corina Guerrero for an unannounced Case Management visit for clearing POC. Present during this inspection was Licensee and assistant supervising 2 infants and 2 preschoolers. Licensee is within the capacity ratio during today's inspection.LPA reviewed the roster and obtained a copy. LPA cleared deficiency cited over Reporting Requirements.

There are no deficiencies cited today. Copy of Cleared POC letters were provided



An exit interview was conducted with licensee, Corina Guerrero. A notice of site visit was posted. Notice of site visit must remain posted for 30 days.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 10/18/2022 09:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: GUERRERO, CORINA
FACILITY NUMBER: 013412831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2022
Section Cited

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Reporting Requirements
In addition to the requirements of Health and Safety Code Section 1597.467(a), no later than the same business day, the licensee shall notify a child's parent or authorized representative of the events to be reported to the Department pursuant to Sections 102416.2(b) and (c) that affect that child.




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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2