274409364-1-31-2023-07-CC-FCJO-CNM2UY-20230131164307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274409364
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:43:10 PM

Document Has Been Signed on 01/31/2023 04:43 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PEREZ, GLORIA		FACILITY NUMBER:	274409364
ADMINISTRATOR:	GLORIA PEREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 754-2362
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 5	DATE:	01/31/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Gloria Perez and Gloria Rocha		TIME COMPLETED:	04:50 PM

NARRATIVE

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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with Gloria Perez, Licensee, and her daughter Gloria Rocha and explained to them the purpose of the inspection is to verify the furniture and equipment for childcare use is in good standing and operable. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, and her spouse Jesus. Licensee's helper and daughter Gloria Rocha was present during the inspection. LPA observed five children included four school age and one preschool child were in care during today's inspection. Licensee Certifications for CPR and First Aid card are current and will expire on 3/06/2023 for both licensee and her daughter Gloria.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. Licensee has documented a fire drill on 1/04/23
LPA inspected the furniture and equipment and observed they seem to be in good operable conditions. LPA observed in 15 children files the forms LIC9224 have been signed for the parents or representatives of the children enrolled in accordance with the AB633 for both reports on 11/04/22 and 11/15/22. LPA observed the home has at least one working carbon monoxide and smoke detectors. The home has a fire extinguisher size 3A40BC serviced on 7/15/22. LPA observed the home does not have any bodies of water. LPA observed barricaded stairs and fireplace, and fenced back yard.

Exit interview conducted and report was reviewed with the licensee's helper and daughter Gloria Rocha.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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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