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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423883
Report Date: 04/16/2026
Date Signed: 04/16/2026 11:20:16 AM

Document Has Been Signed on 04/16/2026 11:20 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:JIMENEZ, ALBA & MONTESINOS, FERNANDOFACILITY NUMBER:
013423883
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: DATE:
04/16/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:11 AM
MET WITH:Fernando MontesinosTIME VISIT/
INSPECTION COMPLETED:
11:34 AM
NARRATIVE
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On 4/16/2026 Licensing Program Analysts (LPAs) Dana Santiago and Nicole Reynoso arrived unannounced Case Management- Licensee Initiated and met with licensees Alba Jimenez and Fernando Montesinos. Residing in the home are the two licensees. There is a finger print cleared adult living in a separate converted garage located in the back of the house. The home was toured to conduct a health and safety inspection. The home operates between the hours of 7:30AM -5:30PM, Monday through Friday. The Licensees have requested to increase the capacity of the facility to a Large Family Child Care Home.
The home is a two story house that consists of five bedrooms, and three bathrooms, which is neat and clean with heating and ventilation for safety and comfort of the children. The entrance to the child care will be the through the fence through and at the side door of the home.
On-limit-areas are the: The two back bedrooms which will be the main areas of the day care, the bathroom near the two bedrooms, the dining/laundry area, living room, outside yard, and the front area of the fenced in backyard.
Off-limit-areas are: The entire upstairs(two bedrooms, small kitchen/family room and bathroom), the converted garage, the fenced in area next to the garage, the left side of the backyard that is fenced off, the kitchen, the master bedroom located next to the living room, office next to living room, walk in closet and the master bathroom, which will be made inaccessible by closed and/or locked doors and visual supervision.
The Isolation area will be one of the on-limit/back bedrooms away from other children in care.

LPAs toured the outdoor area (backyard). LPAs observed there are no pools, hot tubs or other bodies of water. LPA discussed with applicant 100% supervision when children are playing outside. LPAs did not observe any toxins, medications or hazardous items that would be accessible to children. The applicant stated there are no pets in the home and no firearms or weapons on the premises. Report continues on 809C, Page 2
NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Dana Santiago
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JIMENEZ, ALBA & MONTESINOS, FERNANDO
FACILITY NUMBER: 013423883
VISIT DATE: 04/16/2026
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Fire Clearance was approved on 03/25/2026.

The licensees has obtained a signed Property Owner/Landlord Consent form (LIC9149). As of 04/16/2026, licensees are approved for increase in capacity to a Large Family Childcare Home with max capacity of 14 children with a max of 4 infants (under 24 months).

Exit interview conducted, appeal rights were given, and report was reviewed with the Licensees Fernando Montesinos and Alba Jimenez.

A notice of site visit was given and must remain posted for 30 consecutive days.

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Dana Santiago
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC809 (FAS) - (06/04)
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