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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414710
Report Date: 11/18/2020
Date Signed: 11/18/2020 12:57:43 PM

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:RINCON, DIANAFACILITY NUMBER:
274414710
ADMINISTRATOR:RINCON, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 757-1223
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 11DATE:
11/18/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Diana RinconTIME COMPLETED:
12:47 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced Case Management- Licensee Initiated inspection. Due to COVID -19 and shelter in place, a tele-inspection was conducted via Facetime. LPA met with Licensee Diana Rincon and explain the reason for this inspection. The purpose of this inspection is Licensee requested to have Room 1 be on-limits. LPA informed Licensee that a copy of this report will be emailed to her. Licensee's response to the email will serve as acknowledgement that report was received.

Licensee guided LPA on a tour of Room 1. The room was observed to safe for the children. The off-limit areas of the home are the office/computer room, garage, storage room, laundry room, addition in the backyard, and the left side of the yard. An updated facility sketch was submitted to the San Jose Regional Office on 10/01/2020. A fire clearance for 14 children was granted on 03/16/2016.

No deficiencies have been cited as a result of this inspection. An exit interview was conducted where this report was discussed and emailed to Licensee. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020
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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