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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413542
Report Date: 03/16/2021
Date Signed: 03/16/2021 10:15:20 AM

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:ARRIOLA, DENISEFACILITY NUMBER:
434413542
ADMINISTRATOR:ARRIOLA, DENISEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 313-9406
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:14CENSUS: 6DATE:
03/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Denise ArriolaTIME COMPLETED:
09:58 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced Case Management- Licensee Initiated inspection. Due to COVID-19 and shelter in place, a tele-inspection was conducted via Whatsapp. LPA met with Licensee Denise Arriola and explained the reason for this inspection. The purpose of this inspection is Licensee requested to place her living room to on-limits. LPA informed Licensee that a copy of this report will be emailed to her. Licensee's response to email will serve as acknowledgement that report was received.

Licensee guided LPA on tour of the living room via video call. There is a fireplace in the room, which is barricaded. The room was observed to be safe for children. Licensee will be using the kitchen as a walkway for the children to get to the living room. LPA discussed with Licensee about ensuring any sharp objects or cleaning supplies are out of reach of children. The off-limit areas inside of the home are now the storage/office, laundry room, garage, and the entire upstairs. A fire clearance was granted on 03/06/2013. Licensee submitted updated facility sketch.

No deficiencies were cited as a result of this report. An exit interview was conducted where this report was discussed with Licensee. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
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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