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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421174
Report Date: 10/14/2022
Date Signed: 10/14/2022 01:39:54 PM


Document Has Been Signed on 10/14/2022 01:39 PM - 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:SANCHEZ, ROSALBA & ERWINFACILITY NUMBER:
013421174
ADMINISTRATOR:SANCHEZ, ROSALBA & ERWINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 243-5693
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:14CENSUS: 9DATE:
10/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Rosalba SanchezTIME COMPLETED:
01:50 PM
NARRATIVE
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On October 14, 2022, Licensing Program Analyst (LPA) Simerjit Kaur conducted an unannounced Case Management inspection to clear the deficiencies cited during inspection on 10/4/2022. LPA met with Licensees Rosalba Sanchez and Erwin Sanchez. Present during inspection was assistant Joana Cervantesarteag, 5 infant children and 4 preschool age children. Licensee is not incompliance with ratio and capacity limitation during inspection today.

See 809 D for Type A deficiency is cited. Exit interview was conducted with Rosabla Sanchez and appeal rights were provided.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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 10/14/2022 01:39 PM - 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: SANCHEZ, ROSALBA & ERWIN
FACILITY NUMBER: 013421174

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited

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(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement is not met as evidenced by: Based on observation and physical census, the licensee did not comply
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with the section cited above due to 5 infant children in care during todays inspection, which poses an immediate health, safety risk to persons in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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