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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415272
Report Date: 05/03/2019
Date Signed: 05/03/2019 09:54:22 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:ELIZALDE, YESSICAFACILITY NUMBER:
434415272
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Yessica ElizaldeTIME COMPLETED:
10:00 AM
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LPAs Janet Tse and Stephanie Collins met with licensee Yessica Elizalde for a case management inspection. Licensee is applying for an increase of capacity to a Large Family Child Care Home License. Fire clearance was approved on 03/25/2019 by the Santa Clara Fire Department. At arrival, LPAs observed three children including one infant with Licensee's assistant (MM) in the home. Licensee was dropping off her child at school, and returned home later. LPA explained the nature of today's inspection to Licensee. Another child arrived at the facility later during the inspection.

LPA Tse conducted an annual/random inspection on 02/21/2019 at the facility. Deficiencies were cited; and all corrections were made. Deficiencies were cleared. Licensee has all of the required documents for Licensing. LPA observed Licensee has completed training on preventive health practices, and has current CPR and First Aid certification expiring 03/25/2020.

Today, LPAs toured the indoor and outdoor of the facility. LPAs observed a glass door covered fireplace. Stairs were barricaded from the bottom. Off limits indoor, the entire upstairs which consists of three bedrooms and a bathroom. LPAs observed a storage shed barricaded with a piece of nailed shut two-ply wood in the backyard. LPAs observed a deck in the backyard. Off limits outdoor: fenced off areas and both side yards.

The facility is in compliance with Licensing regulations. A license for a Large Family Child Care Home License is approved and effective today, 05/03/2019.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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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