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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408812
Report Date: 04/21/2022
Date Signed: 04/21/2022 10:30:19 AM

Document Has Been Signed on 04/21/2022 10:30 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SERRANO-AREVALO, PATRICIAFACILITY NUMBER:
073408812
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
04/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Patricia Serrano-ArevaloTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Plan of Correction (POC) inspection. Present during the inspection was the licensee, her fingerprint cleared husband, two preschool aged children, and three infants in care.

Licensee was cited on 4/7/22 for operating beyond the limits of the license with having 4 infants and 2 preschool aged children in care. During today's inspection licensee is operating in compliance with title 22 California Code of Regulations. The citation issued on 4/7/22 is cleared today.

Report reviewed with Patricia Serrano-Arevalo
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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