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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415340
Report Date: 02/02/2024
Date Signed: 02/02/2024 01:02:03 PM


Document Has Been Signed on 02/02/2024 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:AVILA, DORINAFACILITY NUMBER:
274415340
ADMINISTRATOR:AVILA, DORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 229-8753
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY:14CENSUS: 0DATE:
02/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Dorina AvilaTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today with the purpose of reactivating the Family Child Care Home (FCCH) license. LPA met with Dorina Avila, Licensee. LPA observed there were no children in care. License has been inactive since 10/04/23. Licensee will provide supervision to children Monday to Saturday from 6:00 AM to 6:00 PM. Licensee’s certifications for CPR and First Aid card is current and will expire on 3/18/25. LPA toured the indoor and outdoor areas of the home during today's inspection.

The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: All second floor with 3 bedrooms and the attached garage, and one bedroom in the first floor. LPA observed there are barricaded stairs. The off-limits areas outside the home are: One she in the right side yard and the side yards. LPA did not observe any wall heaters. LPA observed the home has a backyard and it is fenced. The licensee uses the back yard as playground. LPA observed Licensee has one small dog and one cat in the off limits areas. Licensee stated the pets are vaccinated.
LPA observed a fully charged 3A40BC fire extinguisher that was last serviced on 12/26/23, working smoke/CO detectors. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. The licensee has in the file proof of having immunization for influenza, measles, and pertussis according with the SB792. LPA observed the home has central AC/Heating. LPA observed the home does not have any bodies of water. LPA observed licensee has renewed the Mandated Reporter training on 4/29/23.

The licensee was informed that her FCCH license will be reactivated as of today's date.

No deficiencies were cited today.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Susy CervantesTELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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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