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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416764
Report Date: 05/18/2022
Date Signed: 05/19/2022 08:59:37 AM

Document Has Been Signed on 05/19/2022 08:59 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROCHA, JOANNAFACILITY NUMBER:
274416764
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Joanna Rocha TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted an announced pre-licensing visit with Applicant Joanna Rocha. LPA explained the nature of this inspection. Applicant was the only adult in home during the inspection and her two daughters.

Physical Plant: LPA Larios toured the indoor and outdoor areas of the home during today's visit to see pending items from prior inspection. LPA observed the following: Off limit areas upstairs: master bedroom/bathroom, two bedrooms and bathroom. LPA observed safety knobs to the garage door & pantry door. LPA observed the cords in the left and right side of the fireplace to be taped to the wall and covered with poster(s) and a mini kitchen to avoid access to the cords and to the window A/C. Off limit areas outside the home are as follows: the left side of back yard, due to ladders. LPA observed the four feet fence that leads to the the left side of the back yard. LPA observed all storages with locks and a added door that hold hazardous items. LPA observed the install exit door in the right side of the house. Applicant has submitted updated LIC 999. Pictures were taken of corrected items.

An exit interview was conducted with Applicant and was informed that upon approval of Licensing Management, a license for a Small Family Child Care Home will be granted and issued to Applicant.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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