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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274403160
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:30:25 AM


Document Has Been Signed on 05/05/2022 11:30 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MARQUEZ, AMALIAFACILITY NUMBER:
274403160
ADMINISTRATOR:MARQUEZ, AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 633-0413
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY:14CENSUS: 10DATE:
05/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Amalia MarquezTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with Amalia Marquez, Licensee, and explained to her the purpose of the inspection is for investigate an unusual incident reported to Licensing Program on 4/25/22. Present during today's inspection were ten children, included one infant and nine preschool age. Present also in the home was Licensee's helper and daughter Kimberly.
LPA observed the children were not in contact with the two dogs today. Licensee showed to this LPA where the dogs are kept. LPA reviewed the immunization records for the two dogs and obtained a copy. LPA obtained a copy of the children's roster. Licensee agreed on keeping the dogs away from the children in care during the usual childcare hours which are Monday to Friday from 6:00 AM to 6:00 PM and Saturdays from 6:00 AM to 2:00 PM. Licensee agreed and compromised to keep the dogs in a separate off limits area located in the left side yard and agreed to keep the area inaccessible to the children in care all the time the children are present.

No deficiencies were cited today.


A NOTICE OF SITE VISIT WAS PRINTED, HANDED TO LICENSEE, AND SHALL BE POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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