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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001808
Report Date: 05/09/2022
Date Signed: 05/09/2022 12:41:17 PM


Document Has Been Signed on 05/09/2022 12:41 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MONDOY, BERTA A.FACILITY NUMBER:
384001808
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
05/09/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Berta MondoyTIME COMPLETED:
12:50 PM
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On 5/9/2022 at 12:10A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Licensee, Berta Mondoy. Purpose of the inspection was explained and was for an unannounced, plan of correction inspection. Inspection was established on 4/19/2022. Present was the licensee and licensee's daughter caring for 7 children. (6 preschool age, 1 school age) LPA inspected facility with licensee for health and safety hazards.

During inspection, LPA reviewed facility records and interviewed license. On 4/19/2022, licensee submitted to the department proof of C1's school district enrollment. Enrollment documents have been stored in school-age child’s file.

Deficiencies issued on 4/19/2022, have been cleared and ‘Cleared Plan of Correction Letter’ was provided to licensee.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was discussed with licensee, Berta Mondoy and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice of site visit was provided to licensee and must remain posted for 30 days. Licensee was advised for additional questions to call San Bruno Child care Regional Office, Monday- Friday 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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