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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700382
Report Date: 09/14/2022
Date Signed: 09/14/2022 10:58:08 AM

Document Has Been Signed on 09/14/2022 10:58 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PERUZZARO, ANDRIANAFACILITY NUMBER:
015700382
ADMINISTRATOR:PERUZZARO, ANDRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 784-0117
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Andriana PeruzzaroTIME COMPLETED:
11:10 AM
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
On September 14, 2022, Licensing Program Analysts (LPAs) Simerjit Kaur and Julia Placencia arrived at facility for an announced relocation inspection, and met with the applicant Andriana Peruzzaro. The home was toured with the applicant to conduct a health and safety inspection. The hours of operation are Monday through Friday, 6:30am to 6:30pm.

The home is one story and consists of a kitchen, living room, three bedrooms, one and half bathrooms, garage and a backyard. The home is neat and clean with heating and ventilation for safety and comfort.

ON LIMIT AREAS (accessible to children in care): kitchen, living room, one room for nap located on the left side of hallway, one room for play time located at the end of hallway, one bathroom located on the right side of the hallway, and backyard. The isolation area will be in the living room.

OFF LIMIT AREAS (not accessible to children in care): master bedroom, half bathroom, and garage. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off-limits area to on-limits.
The outdoor play area will be the backyard, which has a fence surrounding the perimeter of the yard, and is free from defects or dangerous conditions. The applicant was advised to ensure that the front gate remains closed while children are outdoors. There are no pools, hot tubs or any other bodies of water.
Continued on LIC 809C.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PERUZZARO, ANDRIANA
FACILITY NUMBER: 015700382
VISIT DATE: 09/14/2022
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
LPA did not observe any hazardous materials or toxins accessible today. Medicine/Vitamins were stored in bathroom cabinet. The home has a fully charged 2A10BC fire extinguisher which is located in the kitchen, working smoke detector, carbon monoxide detector, and telephone.

A copy of the lease agreement has been reviewed and shows control of property. The applicant has provided proof of the immunizations required for daycare providers. Safe Sleep regulations were discussed. Applicant was reminded that children are never to be left in a parked vehicle. Per applicant, there are no firearms in the home. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The applicant was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $500 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.
Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PERUZZARO, ANDRIANA
FACILITY NUMBER: 015700382
VISIT DATE: 09/14/2022
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
Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail.


Applicant will receive license upon receiving the following documents:

1) Current First Aid & CPR certificate

2) Current Mandated Reporter Training certificate

Exit interview conducted and report was reviewed with the applicant Andriana Peruzzaro.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3