<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415847
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:13:01 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:AVALOS, MARIA DEL CARMEN & CERNA, JUANAFACILITY NUMBER:
434415847
ADMINISTRATOR:AVALOS, MARIA DEL CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 346-2243
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 8DATE:
11/08/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria Del Carmen Avalos and Juana CernaTIME COMPLETED:
12:53 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Manager (LPM) Joel Segura and Licensing Program Analyst (LPA) Samantha Yip met with Licensees Maria Del Carmen Avalos and Juana "Joanna" Cerna for a scheduled Informal Meeting via Facetime. The purpose of this meeting was to discuss the recent citation. Licensees were cited on 07/29/2021 for Staffing Ratio and Capacity.

The citation was as followed:
Section 102416.5(e) Staffing Ratio and Capacity
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

Licensees submitted Plan of Correction to Licensing on 07/29/2021 outlining how they will ensure they are within ratio at all times. LPM discussed with Licensees how they will be in compliance in the future. A copy of capacity and ratio was provided to Licensees during inspection on 07/29/2021.

LPM Segura discussed with Licensees about keeping an updated facility roster to ensure that the facility is within ratio and capacity.

LPM Segura explained the informal meeting and the administrative process. Licensees were advised that continued non-compliance with Title 22 Regulations could result in their license being referred to CCL's legal department for review and possible action against the

--------------------CONTINUES ON 809 DATED 11/08/2021 PAGE 2-------------------------------

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: AVALOS, MARIA DEL CARMEN & CERNA, JUANA
FACILITY NUMBER: 434415847
VISIT DATE: 11/08/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
------------------CONTINUATION OF 809 DATED 11/08/2021 PAGE 1-------------------------

license. Assembly Bill 633 (Child Care Parent Notification Requirements) and Acknowledgement of Receipt of Licensing Reports (LIC9224) was also explained and provided to Licensee Maria and Juana via email.

Licensees understood that this department will increase monitoring of the facility for the next twelve months.

An exit interview was conducted with Licensees Maria Del Carmen Avalos and Juana Cerna where this report was discussed. LPM informed Licensees that a copy of this report will be emailed to them. Facility's reply within 24 hours to the email will serve as acknowledgement that the report was received.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2