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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407184
Report Date: 08/07/2019
Date Signed: 08/07/2019 01:21:35 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:NEVAREZ, DIANETH & SOLORIO, GUADALUPEFACILITY NUMBER:
434407184
ADMINISTRATOR:NEVAREZ, D & SOLORIO, GFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 578-1437
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 10DATE:
08/07/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Dianeth NevarezTIME COMPLETED:
01:25 PM
NARRATIVE
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LPA Janet Tse and Investigator Badge #13 Karlyne Amaral met with licensee Dianeth Nevarez for a case management inspection. Present were 10 children including three infants with Licensee, co-Licensee Guadalupe Solorio, and one assistant (EL).

LPA and Investigator were at the facility for another inspection earlier today. At arrival, LPA and Investigator observed an infant was placed outdoor restrained in a lumbar support in an enclosed area immobile made with portable gates which was not set up appropriately. Mats were placed on the floor and on the sides with gaps in between which poses a risk to the health and safety of an infant.

LPA discussed the requirements of AB633 to Licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Deficiency was cited. Notice of site visit was issued and must be posted with type A deficiency cited for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NEVAREZ, DIANETH & SOLORIO, GUADALUPE
FACILITY NUMBER: 434407184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2019
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child receiving services from a family child care home... To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement was not met as evidenced by:
LPA and Investigator observed an infant
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Licensee removed the lumbar support and mats from the enclosed area during the inspection. The infant was placed in a portable crib later. Licensee shall forward a written plan of correction by 08/07/2019 due date with methods and procedures on how to properly accomodate an infant while under her care.
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was placed outdoor restrained in a lumbar support immobile in an enclosed area made with portable gates which was not set up appropriately. Mats were placed on the floor and on the sides with gaps in between.
This poses an immediate risk to the Health, Safety, or Personal Rights of children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
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