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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419077
Report Date: 02/06/2020
Date Signed: 02/06/2020 10:24:34 AM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DELA CRUZ, ILUMINADAFACILITY NUMBER:
013419077
ADMINISTRATOR:DELA CRUZ, ILUMINADAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 523-4652
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 2DATE:
02/06/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Iluminada Dela CruzTIME COMPLETED:
10:30 AM
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On 02/06/2020 Licensing Program Analysts Arminder Singh and Monica Mathur met with licensee, Iluminada Dela Cruz for an unannounced Plan of Correction(POC) inspection. Also present was licensee's fingerprint cleared husband. During the inspection there were two children present (one infant, one preschooler).

01/24/2020 during an unannounced/random inspection, facility was issued citation for:
102417 Operation of a Family Child Care Home: (g)(4). (Type A)
102417 Operation of a Family Child Care Home: (g)(1)
HSC 1597.622 Immunization's

During today's POC inspection LPA's observed:
- No medication/cleaning supplies/poison were kept accessible to children
- Wall heater was properly screened/barricaded
- Licensee and spouse have current immunization records

Signed LIC 9224 is kept in each child's file. Notice of site of 01/24/2020 and report is posted on wall.

Citations were cleared during today's visit. Letter of clearance was issued.

This report was reviewed with the licensee. A NOTICE OF SITE VISIT was issued and must be posted on or adjacent to the interior side of the main door into the home for 30 consecutive days.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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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