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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004346
Report Date: 10/28/2021
Date Signed: 10/28/2021 09:58:47 AM

Document Has Been Signed on 10/28/2021 09:58 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ACEVES, ROSAURAFACILITY NUMBER:
384004346
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosaura AcevesTIME COMPLETED:
10:15 AM
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Licensing Program Analyst, LPA Yee conducted an annual inspection today. The purpose of the inspection was discussed. Present at the facility are the licensee, Rosaura, her daughter Maria and two daycare children. Current residents at the facility are Rosaura, her boyfriend, and 16 years old son. Day-care area: living room, dining room, hallway bathroom, and back yard. The backyard is not being used at this time due to the weather. The remaining areas of the home are off-limit. The facility will provide meals. Infants bring their food. CPR & 1st aid is current until 2/2022 for licensee and helpers. Required immunizations are on file. The home is equipped with a working smoke alarm, a carbon monoxide detector, and a fully charged fire extinguisher. The home has age-appropriate toys and equipment and is in good condition. The facility personnel summary report was reviewed with the licensee and it's current. Child abuse mandated reporter training, AB1207 is current until 8/6/2022. All harmful objects, sharp objects, and toxic are stored out of reach of children and are made inaccessible from children in care. Safe sleep information was discussed. The last emergency drill was conducted in June-2021. The facility meets all posting requirements. The children's files were reviewed and in order. The facility has pets (small dog, bird) and is kept in the off-limit areas.

The facility is in compliance.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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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