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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409084
Report Date: 03/04/2022
Date Signed: 03/04/2022 04:15:35 PM


Document Has Been Signed on 03/04/2022 04:15 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:PULIDO, MAYRAFACILITY NUMBER:
073409084
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
03/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Mayra PulidoTIME COMPLETED:
04:20 PM
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On 3/4/22 at 2:45 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Case Management inspection for Mayra Pulido Family Childcare Home. LPA met with Mayra and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours are Monday to Friday 7:00 AM to 6:00 PM.

Present in the home at time of inspection were licensee, assistant and 5 children ages 11 months-3 years of age. LPA reviewed Facility and Children's records. Licensee is in compliance for the maximum licensed capacity and ratio for a Small Family Child Care Home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

INDOOR SPACE: LPA toured the indoor space of the home. The home consists of living room, dining area, kitchen, 3 bedrooms, 1 bathroom, backyard, 1 separate unit in the backyard, unit bathroom and garage.


IN-USE AREAS: The living room, dinning area, 2 bed rooms, bathroom, backyard, separate unit in the back yard and unit bathroom.
OFF-LIMIT AREAS: Kitchen, 1 bedroom, laundry room and garage which is inaccessible by closed locked doors, safety gates, and visual supervision.
OUTDOOR SPACE: LPA toured the outdoor area (backyard) and observed it was fenced. There are no water body in play yard, LPA discussed with applicant that there needs to be 100% supervision when children are playing with water.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2022
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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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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PULIDO, MAYRA
FACILITY NUMBER: 073409084
VISIT DATE: 03/04/2022
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On 2/3/22 during an informal meeting it was agreed upon that LPA will conduct 2 visits within February and March to ensure the facility is in compliance. Prior to receiving license of a Large family childcare home the facility would need approval from a department manager. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Mayra Pulido.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC809 (FAS) - (06/04)
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