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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703682
Report Date: 07/15/2021
Date Signed: 07/15/2021 12:13:16 PM

Document Has Been Signed on 07/15/2021 12:13 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:OCHOA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703682
ADMINISTRATOR:CHAVEZ, PERLINAFACILITY TYPE:
850
ADDRESS:902 ARIZONA CIRCLETELEPHONE:
(408) 842-2201
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/15/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Perlina ChavezTIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Samantha Yip and Aman Sharma conducted an unannounced Case Management- Annual Continuation inspection. LPA met with Site Director Perlina Chavez and explained the reason for the inspection. The purpose of this inspection was to continue Required 1 Year inspection conducted on 07/14/2021 and to tour Room 4 and review children's and staff files. All staff present during today's inspection have cleared fingerprints.

The facility uses electronic sign in/sign out. LPAs reviewed children that were signed in. Site Director stated that just re-opened on 06/2021 and has not conducted a fire/disaster drill yet. Site Director stated that she will conducted fire/disaster drill and send proof to Licensing.

Site Director stated that they are currently not using Room 4. LPA reminded Site Director that any cabinets with cleaning supplies are locked and any tools, such as ladders are put away.

4 children's files were reviewed during today's inspection. The records reviewed include but not limited to Physician's Report.

1 staff file was reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter training and health screening. LPA observed that staff completed the Mandated Reporter training on 05/16/2019. Director stated that staff completed the Mandated Reporter training and will send proof to Licensing by 5PM on 07/16/2021. Site Supervisor has a valid CPR/1st Aid, which expires on 05/27/2023.

As a result of this inspection, no deficiencies were cited. An exit interview was conducted where this report was discussed and provided to Site Director Perlina Chavez. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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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