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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416431
Report Date: 12/29/2022
Date Signed: 12/29/2022 04:17:25 PM


Document Has Been Signed on 12/29/2022 04:17 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:RIVERA, YANIRAFACILITY NUMBER:
274416431
ADMINISTRATOR:RIVERA, YANIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 261-6983
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 5DATE:
12/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Yanira Rivera TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Elizabeth Larios met with Yanira Rivera, Licensee, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed five day care children. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 5:30 AM to 5:30 PM. Licensee's spouse and family member are the only adults residing in the home.

LPA reviewed a current Child Care Facility Roster. LPA reviewed five children's files and the files were complete with the required forms. No deficiencies cited during todays inspection, exit interview conducted with Licensee's Yanira Rivera and a copy of this report was provided.

The annual inspection will be continued on a later date.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022
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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