<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004656
Report Date: 01/17/2020
Date Signed: 01/17/2020 10:06:57 AM

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:PEREIRA, KAMILLAFACILITY NUMBER:
414004656
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/17/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Pereira KamilaTIME COMPLETED:
10:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Jyoti Saini and Cindy Interiano conducted an unannounced plan of correction (POC) inspection and met with Licensee, Pereira Kamila and Licensee's Husband. Upon LPAs' arrival, present was Licensee caring for 4 children (3 infants and 1 prek). This home is within capacity limits of a Small Family Child Care License. On 01/13/20, this facility was cited for over capacity. Deficiency has been cleared as of today.
POC letter clearing all citations were printed and provided to the licensee.

LPAs provided licensee capacity worksheet in Spanish and English.

Pending manager's review, Large family child care license will continue to be in pending status.



>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

This report was read and reviewed by the Licensee and a notice of site visit was observed posted. Any questions, call San Bruno Regional office (650) 266-8800
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1