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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005509
Report Date: 12/08/2021
Date Signed: 12/08/2021 10:37:18 AM

Document Has Been Signed on 12/08/2021 10:37 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PAZ, NAYARA O.P. AND RONCATO, BRUNO R.FACILITY NUMBER:
214005509
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/08/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Nayara Paz, Bruno RoncatoTIME COMPLETED:
09:35 AM
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On 12/8/2021 at 9:05A.M, Licensing Program Analyst (LPA) Luis J. Gomez met with Licensees, Nayara Paz and Bruno Roncato. Purpose of inspection was explained and was an unannounced, plan of correction inspection. Present was both licensees and one helper caring for 6 children. (Three Infant Age and Three Preschool Age). LPA inspected facility, inside and outside, with the licensees for health and safety hazards.

On 11/12/2021, the Department received licensee's updated children’s schedule. During today's inspection, LPA observed licensees operating below capacity limits stated on the license. Signed Acknowledgement of Receipt of Licensing Report (LIC9224) have been stored on each child's files.

Deficiency issued on 11/10/2021 have been cleared. Cleared Plan of Correction Letter was provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with licensees and their signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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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