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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 05/23/2019
Date Signed: 05/23/2019 02:45:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PORTILLO, JESSICA J.FACILITY NUMBER:
414004462
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/23/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee, Jessica Portillo TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee Jessica Portillo for a plan of correction visit established on 5/14/2019. There are 4 children present during the visit; (4 preK). Licensee is within capacity limit for a small license. The following deficiency from the previously inspection was checked today:


102416.5(a) Staffing Ratio and Capacity. This requirement was not met as evidenced by LPA observed licensee is over her capacity limits of the license.


Deficiency issued on 5/14/2019 have been cleared. 'Cleared POC Letter' was given to Licensee.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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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