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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404726
Report Date: 06/25/2020
Date Signed: 06/25/2020 04:59:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:RIVERA, FELICITASFACILITY NUMBER:
434404726
ADMINISTRATOR:RIVERA, FELICITASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 259-2064
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 8DATE:
06/25/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:51 PM
MET WITH:Felicitas RiveraTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced Tele visit via FaceTime for a case management inspection. LPA met with licensee Felicitas Rivera with the purpose of inform licensee that her facility did not pass the fire Inspection. LPA observed licensee and her helper are taking care of 8 children. Licensee understands fire department clearance is mandatory for a large family child care home license. Licensee agreed that the Department request a new Fire Clearance on her address and agrees in follow up with the Fire Department requirements. LPA observed the cover on the patio has been torn down. Licensee stated the patio cover was removed the first week of May 2020. Licensee submitted to this Department pictures showing the place were used to be the patio cover.

No deficiencies have been cited today. This inspection was conducted in Spanish with licensee Felicitas Rivera.

A NOTICE OF SITE VISIT WAS ISSUED, PRINTED AND EMAILED TO LICENSEE AND LICENSEE MUST POST IT NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
This report has been email to licensee and licensee will reply the email in lieu of a signature.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020
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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