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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409221
Report Date: 11/16/2021
Date Signed: 11/16/2021 01:57:00 PM

Document Has Been Signed on 11/16/2021 01:57 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:LARA, GABRIELAFACILITY NUMBER:
434409221
ADMINISTRATOR:GABRIELA LARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 843-8720
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 2DATE:
11/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Gabriela LaraTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Gabriela Lara for a Plan of Correction visit. LPA explained the nature of the visit. Present were licensee, licensee's husband, adult son Isaac Lara Aguilar and daughter Stefany Lara, three year old daughter and two day car children including one infant. Isaac does not have fingerprint clearance. Licensee was informed during visit on 10/07/2021 that son could not be present in the home until he obtains clearance. A civil penalty of $100 is being assessed today.

LPA toured the inside and outside of the home. LPA observed the fence around the pool was changed but the fence to enter was not. The fence does not meet regulation standards and is only 4ft 10 1/2/ inches high. LPA observed the back area of the yard was not secured with proper fencing. The fence was off it's hinges and fell down. LPA observed cactus, work tools and building material in the area. LPA observed the emergency exit to the right of the yard was cleared and no hazards were observed.

The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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Document Has Been Signed on 11/16/2021 01:57 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 11/16/2021 at 12:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LARA, GABRIELA
FACILITY NUMBER: 434409221

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/17/2021
Section Cited
CCR
102370(d)(1)

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102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee will resubmit fingerprints for Isaac Lara Aguilar and understands he may not be present in the home until clearance is obtained.
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This requirement was not met as evidenced by Isaac does not have fingerprint clearance. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/16/2021 01:57 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 11/16/2021 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LARA, GABRIELA
FACILITY NUMBER: 434409221

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2021
Section Cited
CCR
101417(g)(5)(A)

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Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.
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Licensee will replace the fence to make it meet regulation standards and submit photos that the fence is 5ft high.
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This requirement was not met as evidenced by The fence does not meet regulation standards and is only 4ft 10 1/2 inches high. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
11/19/2021
Section Cited
CCR102417(g)

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The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced by LPA observed the back area of the yard was not secured with proper fencing. The fence was off it's hinges and fell down.
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Licensee will clean area or put proper fencing to ensure children do not have access to hazardous items.
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LPA observed cactus, work tools and building material in the area. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


LIC809 (FAS) - (06/04)
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