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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409684
Report Date: 01/24/2025
Date Signed: 01/24/2025 05:36:59 PM

Document Has Been Signed on 01/24/2025 05:36 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:MADRIGAL LOMBERA, PERLAFACILITY NUMBER:
073409684
ADMINISTRATOR/
DIRECTOR:		MADRIGAL LOMBERA, PERLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 609-8165
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/24/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Perla Madrigal LomberaTIME VISIT/
INSPECTION COMPLETED:
05:40 PM
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On January 24, 2025, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced prelicensing inspection. LPA met with applicant Perla Madrigal Lombera. The applicant lives in the home with her husband and minor son. LPA toured the home for a health and safety check. The applicant plans to care for ages 0 months - 10 years old, and operate on Monday - Friday, 6am - 6pm.

The home is a single family house consisting of four bedrooms, two bathrooms, a converted garage, a fully fenced in backyard with two side yards.

The Off Limit Areas are the three bedrooms at the back of the home, living room,kitchen, 2nd bathroom to the left of the hallway, side yard to the right of the home, and backyard. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.


The On Limit Areas are the converted garage (to be used as a play room), the bedroom next to the garage, and the side yard to the left of the house.
Isolation Area - in the play room

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. The main daycare area is in the converted garage. LPA did not observe any medication, bodies of water, or poisons accessible to children during the inspection today. Per applicant there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a working combined smoke and carbon monoxide detector in the living room and when tested it all the alarms in the home get activated. The applicant's CPR certificate expires June 24, 2025. The applicant's Mandated Reporter certificate for Childcare Providers expires on 8/3/2025. The applicant plans on utilizing the side yard to the left if the home for outdoor play. The home has a central heating system, there were a wall heater or a fire place in the home.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MADRIGAL LOMBERA, PERLA
FACILITY NUMBER: 073409684
VISIT DATE: 01/24/2025
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LPA reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children. LPA left copies with the applicant. LPA advised the applicant of where to obtain additional copies of the forms. Applicant was reminded that the required documents must be visible for the public at all times during hours of operation. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPA reviewed children's personal rights and the applicant confirmed that she understands that children's personal rights should not be violated and no corporal punishment is allowed. LPA reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPA reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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: MADRIGAL LOMBERA, PERLA
FACILITY NUMBER: 073409684
VISIT DATE: 01/24/2025
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On January 24, 2025 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Applicant was reminded that children are not allowed to eat or nap in the converted garage.

The applicant owns the home and has provided proof of control of property.


A License for a large Family Daycare is being granted effective today, January 24, 2025.

Exit interview conducted. Report reviewed and provided to Licensee Perla Madrigal Lombera.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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