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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416052
Report Date: 09/05/2023
Date Signed: 09/05/2023 02:16:37 PM

Document Has Been Signed on 09/05/2023 02:16 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:ESTRADA MEDRANO, BRENDAFACILITY NUMBER:
274416052
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Brenda Estrada MedranoTIME COMPLETED:
02:25 PM
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On 09/05/2023 at 01:55 PM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee, Brenda Estrada Medrano, for a case management visit to increase capacity and explained the reason for the visit to them. Present was licensee and her assistant/daughter with 2 preschool children in care.

Facility had an annual inspection conducted on 05/15/2023 and no deficiencies were cited during the visit. LPA received a fire inspection clearance from the Soledad Fire Department prior to today's visit. LPA was shown by licensee the emergency exit routs and asked if the inspector had asked them to make any changes, licensee stated only to take off the lock for the emergency exit door. LPA observed a 2A10BC fire extinguisher that was checked on 08/24/2023. Smoke and carbon monoxide alarms were operable. LPA reminded licensee that their mandated reporter class is due in two day. Information from last annual visit: disaster drill log was last conducted on 04/24/23. LPA observed that the Licensee and assistant have Mandated Reporter training that was completed on 09/07/21 and 05/25/22. Licensee and assistant have Pediatric CPR/1st Aid expiring 02/01/24 and 03/17/24. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee and assistant.

Exit interview conducted and report was reviewed with the licensee, Brenda Estrada Medrano. LPA advised applicant that licensure for a large Family Child Care Home license is approved pending the following:

- Management's approval
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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