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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422861
Report Date: 08/05/2020
Date Signed: 08/05/2020 11:56:38 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:VAZQUEZ DE RODRIGUEZ, KARINAFACILITY NUMBER:
013422861
ADMINISTRATOR:VAZQUEZ, KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(702) 339-1444
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:14CENSUS: 7DATE:
08/05/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karina Vazquez de Rodriguez TIME COMPLETED:
12:00 PM
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****DUE TO THE COVID-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS CASE MANAGEMENT VISIT WAS DONE VIA TELE-VISIT THROUGH FACETIME***

On 8/5/2020 at approximately 11AM, Licensing Program Analyst (LPA) Junell Chen met with Licensee Karina Vazquez de Rodriguez (VIA TELE-VISIT FACETIME CALL) for an unannounced case management inspection for the purpose of adding on-limits areas to the licensee's home day care. Present for this visit was licensee and fingerprint cleared assistant helper Mohini Singh, and four preschoolers and three school-age children present today.

Licensee would like to add the play room and backyard to her facility on-limit areas. LPA inspected the play room and backyard. The play room is an extension to the living room quarters. The backyard can be accessed through the play room. Both the play room and backyard have been observed with no health or safety concerns at this time during the tele-inspection today. There exists ample age appropriate toys for daycare children as being observed today during the tele-inspection.

The on limit areas are the play/dining room, backyard, living room, three bedrooms, front yard, kitchen, and hallway bathroom.

This report has been read to the Applicant in its entirety. An exit interview was conducted with the Applicant. Copy of reported provided. This report is to remain in the facility records for three years from today's date.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020
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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