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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004652
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:26:09 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:VALENCIA, KARLA G.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 921-8049
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:14CENSUS: 6DATE:
08/24/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karla ValenciaTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tapia-Mandujano conducted a Case Management visit to cite licensee for having an adult residing in the home prior to receiving fingerprint clearance. Purpose of the visit was explained. Present in the home are licensee, two assistants, adult resident, and six children (2 infants, and 4 preschool age). All adults present are fingerprint cleared.

LPA and licensee observed the room where resident was living. LPA observed adult who has fingerprint clearance and personal items. Per licensee, resident is no longer sleeping there and/or is present in the home pending fingerprint clearance. Licensee stated that resident has told her that starting September 1st he will officially move out since the process to receive fingerprint clearance is prolonging. Licensee understands that prior to any individual moving in or working at daycare, they must receive fingerprint clearance or exemption.

Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Plan of correction and exit interview was conducted with Licensee, Karla Valencia and her signature of this form acknowledges receipt of these documents. Appeal rights were provided during inspection.

A copy of this report will be emailed to GROWINGANDLEARNING@HOTMAIL.COM. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266-8800
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2021
Section Cited

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102370(a): Criminal Record Clearance: " Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption." This evidence is not met by:
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Based on LPA interviews and record review, there was an individual who was residing in the home prior to receiving fingerprint clearance or exemption.
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Licensee has asked individual to not be sleeping/present in the home prior to receiving fingerprint clrearance or exemption.

Per licensee, individual will be completely moved out by 09/01/21.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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