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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274409364
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:09:52 PM

Document Has Been Signed on 08/15/2023 12:09 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, GLORIAFACILITY NUMBER:
274409364
ADMINISTRATOR:GLORIA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 754-2362
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Gloria TIME COMPLETED:
12:15 PM
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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 Rocha, Licensee's helper and daughter, and explained to her the purpose of the inspection is to verify that the furniture and equipment for childcare use are 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. LPA observed that four children were present, included two preschool age, one infant and one school age. Licensee Certifications for CPR and First Aid card are current and will expire on 2/18/25 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 8/01/23
LPA inspected the furniture and equipment and observed they seem to be in good operable conditions. LPA observed in the children's roster that two new children have been enrolled and attending, LPA observed in their files the forms LIC9224, in accordance with the AB633 for both of the reports dated 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 6/06/23. 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 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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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