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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407145
Report Date: 07/22/2021
Date Signed: 07/22/2021 12:26:00 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:AGUIRRE, IRENEFACILITY NUMBER:
444407145
ADMINISTRATOR:AGUIRRE, IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 421-0321
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:14CENSUS: 10DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Irene AguirreTIME COMPLETED:
12:45 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 Analyst (LPA) Goodell met with licensee, Irene Aguirre, for the purpose of an Unannounced Annual Random Inspection. Hours of operation are Monday- Thursday, 8:00am- 4:30pm. During inspection, LPA observed 10 children present with licensee and two assistants. All individuals subject to criminal background review have obtained a criminal record clearance. Required postings were observed.

Inspection was conducted in all areas accessible to children. Off-limits areas include master bedroom and closet. LPA verified current phone number and email are current. LPA also observed a 2A10BC fire extinguisher, duel smoke and carbon monoxide detectors. No weapons, bodies of water or poisons observed in the home. Licensee acknowledged that 100% supervision is required in unfenced area. LPA observed cleaning compounds, medication and knives are stored inaccessible to children. Children records and staff files were reviewed. LPA observed fire drill log and children roster maintained. Preventative health training, current pediatric CPR and first aid certification was verified and expires 9/2022. The Effects of Lead Exposure brochure was issued and discussed. All Inclined sleepers are prohibited per: PIN 19-16-CCP was discussed. No infants present. Safe Sleep Awareness were issued and discussed. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information.

No Title 22 Deficiency cited. LPAs reviewed report with the licensee and provided copies. An exist interview was conducted. The Notice of Site Visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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 1