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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004876
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:01:19 PM

Document Has Been Signed on 10/13/2023 03:01 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LOPEZ GUZMAN, DAISY N.FACILITY NUMBER:
414004876
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Daisy Lopez GuzmanTIME COMPLETED:
03:10 PM
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On 10/13/2023 at 2:05PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Daisy Lopez Guzman. Purpose of inspection was explained and was for an unannounced, Follow-up: Case Management inspection for increase of capacity. Present was the licensee, helper caring for two children. Children present are infant- age. All adults have criminal record clearances on file. Licensee home is a 3 bedroom, 2 bathroom, 1 level unit. Days and hours of operations are: Monday- Friday, 8:00 AM., to 5:30 PM. Day-care Areas are: Living Room (Playroom), Bedroom #1 (Napping only), Dining Room, Bathroom #1 and the Outdoor Play Area (Patio). Off-limit Area are: Bedroom #2, Bedroom #3, Bathroom #2, Garage Area, #1 (Pass through only), Garage Area #2 (Pass through only), Garage Area #3/ Studio unit, Kitchen (Pass through only) and Laundry Area. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards.

At 2:20PM, LPA observed the following: All detergents, cleaning supplies, located in garage area #2, have been placed on a high shelf. LPA observed several safety locks installed on drawers in kitchen.

LPA observed water heater tank and dryer have been made inaccessible to children.


LPA reviewed home’s studio unit (Garage #3) during inspection.

On 10/13/2023, Licensee will be recommended for approval of Increase in Capacity/ and Room Additions.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapter. 3**



Report was reviewed and copy was issued to Licensee, Daisy Lopez Guzman. This report will be kept in the facility file and made available for public review upon request.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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