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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413159
Report Date: 05/22/2023
Date Signed: 05/30/2023 02:30:26 PM

Document Has Been Signed on 05/30/2023 02:30 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:NAVARRO, ANABEL & SOCORROFACILITY NUMBER:
274413159
ADMINISTRATOR:NAVARRO, ANABEL & SOCORROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-1613
CITY:ROYAL OAKSSTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
05/22/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Anabel & Socorro NavarroTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Elizabeth Berumen, conducted an unannounced Plan of Correction (POC) inspection to the Facility today. LPA met with licensees, Anabel and Socorro Navarro and explained the nature of today's visit to them. The purpose of the inspection is to review POCs for deficiencies that were cited on 04/25/23. Present during today's inspection were licensees and 5 day care children (one infant, one preschool and three school age).
The facility was issued three "Type A" deficiencies on 04/25/2023 for criminal record clearance, accessible cleaning products toxins and safe sleep. "Type B" for Socorro Navarro missing the Mandated Reporter Training, missing LIC9227 infant file, and children missing proof of immunizations.

Licensee submitted all the POCs and, a plan of correction statement to the office prior to POC due date. LPA also observed that the Acknowledge of Receipt of Licensing Reports were signed by the parents of children in care and kept in each child's records. LPA observed the Notice of Site Visit, LIC 9099 & LIC 9099-D reports which were issued 04/25/23 were posted on wall next to the facility entrance door.

LPA concludes that the facility has completed its required plan of corrections and the deficiencies are thus cleared as of today's visit.

No deficiency was cited for this visit. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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