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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001759
Report Date: 03/19/2025
Date Signed: 03/27/2025 09:57:29 AM

Document Has Been Signed on 03/27/2025 09:57 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CHAVEZ, MONICA & AVILES, MONICAFACILITY NUMBER:
414001759
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, MONICA & AVILES, MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 568-9845
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Monica ChavezTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On March 18, 2025 @ approx. 1:15 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted a case management visit regarding recent damage to home and required evacuation by city.

On 03/12/2025 home sustained damage due to a fallen tree. LPA toured the home for health and safety hazards. Per LPA's observations bedroom #2 and #3 sustained damage, LPA did not observe any damage to bedroom #1 or bathroom. Per sign posted by city, all three bedrooms and bathroom on left side of home have been deemed no entry/off limits. Per letter provided to licensee from building inspector, the left side of the home has been cleared by the city for use which includes the kitchen, living room, converted garage (one bedroom and storage room), bathroom #2 and daycare room.

Daycare will continue to operate in the daycare room and in bathroom #2. Kitchen, living room, converted garage will remain off limits to children in care. Bedroom #1, #2 #3, hallway and bathroom #2 are deemed no entry by city. Licensee understands children are not allowed to be in off limits and no entry areas.

Per Licensee (L1), L1, L1’s brother (A1) will continue to live in home. L1’s daughter recently moved into home and will also continue to live in home. Per licensee, A1 will stay in converted garage bedroom and L1 and L1’s daughter will be staying in living room and daycare room. Licensees mother (L2), licensees brother (A2), and A2 minor child will not be living in home temporarily. Licensee was reminded that children are not allowed into off limits areas and the city deemed off limits areas.

Off entry areas will be barricaded with a gate and a door by construction company during reconstruction and to keep areas off limits. Licensee agrees to keep CCLD posted when repairs will be completed. A fire inspection clearance will be requested, and a case management visit will be required once all repairs have been completed.

Per Fire Marshall and Building inspector, approved daycare areas have been cleared to operate as of tomorrow March 19, 2025. Fire department will submit a fire life inspection report to licensing department.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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