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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700287
Report Date: 10/04/2021
Date Signed: 10/04/2021 08:39:55 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:PERUZZARO, ANDRIANAFACILITY NUMBER:
015700287
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
10/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Andriana PeruzzaroTIME COMPLETED:
12:30 PM
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On 10/04/2021, Licensing Program Analyst (LPA) Jaylena Miller conducted a Case Management Visit. LPA met with licensee Andriana Peruzzaro for an announced change of location Inspection. The licensee plans to operate Monday-Friday from 7:00am-4:30pm. LPA conducted a health and safety inspection inside and outside with licensee.

The home is a single story home with 2 bedrooms including a master bedroom with bath, 1 bathroom that will be used for the children in care, a living room, a kitchen with dining area and back patio which is completely fenced in. The home is neat and clean with central heating and ventilation for safety and comfort. There are no pools, hot tubes or any other bodies of water present at the facility during today’s inspection. All hazardous materials and toxins are kept out of reach from children and would not be accessible to children during today’s inspection. The home has a working smoke detector, carbon monoxide detector, fully charged fire extinguisher size 2A-10-BC, and first aid kit. Per licensee, there are no firearms on the premises. The entire home is on limits and LPA reminded licensee that when using the back patio 100% visual and physical supervision is required.

The Licensee has received certificates of completion in Health and Safety but not the lead poison prevention training, the mandated reporter training, and CPR and First Aid which is current and expires 12/01/2021. LPA Miller discussed with licensee the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved.

LPA reminded licensee a roster of the children must be properly maintained, and the fire/disaster drills every six months must be documented.



This home will be recommended for a licensure as of 10/04/2021.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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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