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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412902
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:15:07 PM

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:GUZMAN, ROSARIOFACILITY NUMBER:
013412902
ADMINISTRATOR:ROSARIO GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 516-8261
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 0DATE:
01/07/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Rosario Guzman- LicenseeTIME COMPLETED:
12:30 PM
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On 1/7/21 at 11:45am, Licensing Program Analyst (LPA) Briana Plumboy met with licensee Rosario Guzman for an unannounced Case Management inspection which was initiated by the licensee. This facility was on inactive status effective 06/09/21 and would like to be placed back on active status. The facility currently operates from 6:00am until 6:00pm, and per licensee, she is flexible with the families. Families enter licensees home through the side gate.

The home is single story. The home has heating and ventilation for safety and comfort. The ON LIMIT AREAS are the hallway bathroom, living room, and enclosed day care room. The OFF LIMIT AREAS are the 3 bedrooms, family room, master bathroom, kitchen/dining room, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be an area located inside the day care room. The BACKYARD play area is fenced for for children's use. There are toys and learning materials. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection. LPA Plumboy discussed the importance of keeping hazardous items out of the reach of children. Licensee has a current CPR and First Aid certificate which expires 09/18/22. The facility has a working smoke detector, working carbon monoxide detector, and 3A40BC fire extinguisher. The licensee's mandated reporter training is complete and she received a certification of completion on 01/01/24.

The facility is placed back on active status. No deficiencies cited during today's inspection. An exit interview was conducted. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted applicant.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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