<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408678
Report Date: 06/18/2020
Date Signed: 06/18/2020 06:09:22 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DELGADO, VIRGINIAFACILITY NUMBER:
073408678
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/18/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:18 PM
MET WITH:Virginia DelgadoTIME COMPLETED:
06:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 18, 2020 at 4:18PM Licensing Program Analyst (LPA) Catherine Fernandes conducted a tele visit with Licensee Virginia Delgado regarding an increase in capacity. Residing in the home is the licensee, her finger print cleared husband, two adult daughters and underage child. Present during the inspection were four preschoolers and a finger print cleared assistant. The home was inspected to conduct a Health and Safety check. Due to COVID-19 LPA focused mainly on the physical plant of the home and an annual will follow.
The home is a two story house which is neat and clean for the safety and comfort of the children. The home consists of four bedrooms and three bathrooms. Operating hours will be 8:00am to 5:00pm, Monday through Friday. The OFF LIMIT AREAS are the entire second floor of the home, and on the first floor the garage and laundry room which will be inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the converted living room which is the main area of the day care, the kitchen, dining room, the family room, the bedroom next to the family room and the fenced in backyard. The ISOLATION AREA will be in the family room on the couch. LPA did not observe any hazardous materials or toxins accessible to children today.
The home has a fully charged 3A40BC fire extinguisher on the wall next to the kitchen, a pull down fire alarm next to the entrance of the home, working smoke detector and carbon monoxide detector, telephone, and First Aid Kit. The Licensee's CPR and First Aid certificate is current and expires on 01/25/2022. There is a fire place in the family room that is covered to prevent access by children. Per applicant, there are no firearms in the home. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required mandated reporter training, which has been completed on 12/21/19.
There was an approved fire clearance received on 06/10/2020. LPA is recommending the increase in capacity for this facility effective today.

Exit interview conducted with Licensee. Report emailed and mailed.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2020
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 1