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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700346
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:47:22 PM

Document Has Been Signed on 07/27/2023 03:47 PM - 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FALCON, YSAMELFACILITY NUMBER:
015700346
ADMINISTRATOR:FALCON, YSAMELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-4829
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
07/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Ysamel FalconTIME COMPLETED:
03:45 PM
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On July 27th, 2023 at approximately 1:35pm, Licensing Program Analyst (LPA) April Wright met with licensee Ysamel Falcon for an Unannounced Case Management Inspection.

Present during inspection were fourteen (14) children (3 infants, 9 preschool and 2 school age children) and fingerprint cleared assistant Monika De Jesus Rodriguez. The licensee is in ratio today. Hours of operation are 7:00am - 6:00pm Monday through Friday.

Visit is a follow up to Licensees Annual visit which was conducted on 4/24/2023. Licensee had a total of seven (7) deficiencies which are listed below.
  • Type A - LPA observed 3 children in infant seats/bouncers/rockers while sleeping
  • Type A - Licensee was out of ratio - 15 children present (2 infant /13 preschool age children)
  • Type B - Assistant does not have current Mandated Reporter Training
  • Type B - Consent for Medical Treatment LIC627 in not present in C1, C2, C3, C7 file
  • Type B - Immunization's are not present in C2, C3 file
  • Type B - Infant Sleep Plan LIC 9227 not present in C7, C14 file
  • Type B - Sleep log not present in C7, C14 file


LPA observed that Licensee is in compliance and all Citations have been cleared as of today's visit and via emails from Licensee.

No deficiencies were cited during today's visit.

Report read and Notice of site visit given to Licensee Ysamel Falcon.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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