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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415847
Report Date: 05/19/2022
Date Signed: 05/19/2022 10:51:34 AM


Document Has Been Signed on 05/19/2022 10:51 AM - It Cannot Be Edited

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: 12DATE:
05/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria del Carmen Avalos and Juana "Joanna" CernaTIME COMPLETED:
09:55 AM
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Licensing Program Analysts (LPAs) Samantha Yip and Ted Trujillo conducted an unannounced Plan of Correction (POC) inspection. LPA met with Licensee Maria del Carmen Avalos and Juana "Joanna" Cerna and explained the reason for the inspection. Present during today's inspection were Licensees Maria, Licensee Juana, and 12 children, whom three were infant age.

Licensees were cited on 05/11/2022 for staffing ratio and capacity due to Licensees having 13 children whom none were attending kindergarten and four infants during the inspection. LPA obtained a copy of roster and reviewed documentation for sleep log during today's inspection. Facility was within ratio during today's inspection.

No deficiencies were cited during today's inspection. Exit interview conducted and report was reviewed with Licensees Maria Avalos and Juana Cerna. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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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