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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409190
Report Date: 07/19/2023
Date Signed: 07/19/2023 11:39:25 AM

Document Has Been Signed on 07/19/2023 11:39 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:RUBIO, MARIAFACILITY NUMBER:
073409190
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
07/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria RubioTIME COMPLETED:
12:00 PM
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On 7/19/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Maria Rubio's day care home for CAPACITY INCREASE to Large Family Childcare Home. Fire clearance was granted on on 7/5/23 and states gate on side of home requires to remain unlocked.

Present in the home were Licensee and 4 day care children (3 infants, 1 preschool age). Facility is in ratio compliance today. Licensee wants to add the large bedroom for day care use as a Play Room. LPA inspected the bedroom and granted approval for use effective today.
INDOOR IN USE AREAS: Entry area near kitchen, Play room, Living/Dining space, 1 bedroom for naps (middle room), Large Bedroom (new playroom), Bathroom in hallway, Kitchen.
INDOOR OFF LIMITS: 1 bedroom, Renters' residences (two separate in-law units), Detached garage, 3 outdoor storage sheds
OUTDOOR AREAS: Children use the far end backyard for outdoor activity. They walk through the pathway between the renter's unit on left and detached garage on right side; through the gate, into the play yard. The yard is fenced on all sides. No bodies of water were observed. 3 Storage sheds are locked.

Children and Licensee files were reviewed. Licensee's CPR/First Aid certification and Mandated Reporter training is current and updated. LPA reviewed large family home ratios and assistant requirements. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. Facility is approved for Capacity Increase. Exit interview was conducted with Licensee, Maria Rubio. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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