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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004688
Report Date: 07/22/2022
Date Signed: 07/22/2022 01:03:08 PM

Document Has Been Signed on 07/22/2022 01:03 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:BRAVO, JULIA A.FACILITY NUMBER:
414004688
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Julia Bravo TIME COMPLETED:
01:15 PM
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On 7/22/2022 at 12:20PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Licensee, Julia Bravo. Purpose of the inspection was explained and was for an unannounced; plan of correction inspection. Present was the licensee and no children. LPA inspected facility for health and safety hazards.

At 12:25PM., Based on record review, LPA confirmed C1's authorized representative had the signed the required Identification of Emergency Information (LIC700) and Individual Infant Sleeping Plan (LIC9227). Per licensee, infant-age child, C1, will no longer be returning.

Deficiencies issued on 6/28/2022, have been cleared and ‘Cleared Plan of Correction Letter’ was provided.

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 was discussed with Licensee, Julia Bravo and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Director was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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