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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004652
Report Date: 01/09/2020
Date Signed: 01/09/2020 03:23:46 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:VALENCIA, KARLA G.FACILITY NUMBER:
414004652
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
01/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee, Karla ValenciaTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Cindy Interiano, conducted a Case management inspection and met with Licensee, Karla Valencia. Purpose of the inspection was explained. Present during the inspection was Licensee and Helper caring for 6 children (2 infants and 4 PreK). LPA inspected home for Health and Safety hazards. Daycare areas are: Living Room, Bathroom #1, Dining area, (converted) Garage, Sideyard #1 (adjacent to Garage), and Backyard. Off limit areas are: Kitchen, Laundry area (in Garage), Master Bedroom #1 with Bathroom #2, Bedroom #2, Bedroom #3, Sideyard #2 (adjacent to Bedroom #3), and all closets. All off limit areas are properly barricaded. LPA reminded Licensee to maintain second exit pathway through the backyard gate clear of any objects.

Capacity limits of a Small and Large License has been reviewed with Licensee. Licensee was reminded that when operating at a Large capacity, there must be a Helper present.

Licensee states Fire inspector inspected facility on 12/16/19 and provided clearance.
LPA advised Licensee that once fire clearance is received, the Large capacity License will be mailed to her.

**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 kept in the facility available for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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