Community Care Licensing

FACILITY NAME:	LARA, GABRIELA		FACILITY NUMBER:	434409221
ADMINISTRATOR:	GABRIELA LARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 843-8720
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 2	DATE:	11/16/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Gabriela Lara		TIME COMPLETED:	02:05 PM

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Deanna Villagrana TELEPHONE: (408) 335-9890 LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021

Document Has Been Signed on 11/16/2021 01:57 PM - It Cannot Be Edited

FACILITY NAME: LARA, GABRIELA	FACILITY NUMBER: 434409221
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 11/17/2021 Section Cited	1 2 3 4 5 6 7	102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by Isaac does not have fingerprint clearance. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14	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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SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Deanna Villagrana TELEPHONE: (408) 335-9890 LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021

Document Has Been Signed on 11/16/2021 01:57 PM - It Cannot Be Edited

FACILITY NAME: LARA, GABRIELA	FACILITY NUMBER: 434409221
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/19/2021 Section Cited	1 2 3 4 5 6 7	Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by The fence does not meet regulation standards and is only 4ft 10 1/2 inches high. This poses a potential risk Health, Safety Personal Rights risk to children in care.	8 9 10 11 12 13 14
Type B 11/19/2021 Section Cited	1 2 3 4 5 6 7	The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced by LPA observed the back area of the yard was not secured with proper fencing. The fence was off it's hinges and fell down.
	8 9 10 11 12 13 14	LPA observed cactus, work tools and building material in the area. This poses a potential risk Health, Safety Personal Rights risk to children in care.	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Deanna Villagrana TELEPHONE: (408) 335-9890 LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021