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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621704
Report Date: 08/01/2019
Date Signed: 08/08/2019 02:51:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ALVAREZ, JESSICAFACILITY NUMBER:
343621704
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
08/01/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jessica AlvarezTIME COMPLETED:
02:45 PM
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LPA Kelly met with Licensee, at the family child care home for a case management visit for the purpose of increasing capacity from 8 to 14 children. Home is a one story, 4 bedrooms and 2 bath. There were 6 children present at time of inspection.

Off limit areas: 3 bedrooms, master bath and garage. All areas to be used for care were inspected. The home has a fire extinguisher and operable smoke and carbon monoxide alarm. All soaps, detergents, sharp kitchen utensils, etc. have been stored according to regulations. Licensee stated there are no firearms in the home. The backyard is fenced, contains a big locked shed for storage that is off-limit and there were no bodies of water. Applicant has current required 15 hours of preventative health training and proof of current 1st aid and CPR certificates. Adult residents have criminal record and Child Abuse Index clearances. Licensee obtained the $300,000 liability insurance insured thru Farmer. LPA also reviewed the files of the children in care and found that applicant is presently using the required forms. LPA discussed Regulation 1597.622 (Employees and volunteer immunization) with licensee.

There were no deficiencies observed.

The Fire Safety Inspection Clearance has been received from the Fire Marshall and home has been cleared for up to 14 children on 7/24/19.

Effective date: 8/1/19, licensee is license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will fall back to the small capacity.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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