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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412779
Report Date: 07/26/2024
Date Signed: 07/26/2024 03:34:37 PM

Document Has Been Signed on 07/26/2024 03:34 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GONZALEZ, ARCELIAFACILITY NUMBER:
434412779
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, ARCELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 310-0239
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
07/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Arcelia GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Arcelia Gonzalez for a case management visit. LPA explained the nature of the visit. Present were licensee, licensee's sister Elena Barba who is her assistant, 16 year old son, nine year old daughter and four day care children including two infants.

LPA observed an addition inside the home was made. Licensee states her husband split a bedroom by adding a wall to make one room into two and failed to notify the Department of changes to the home. LPA asked if permits were obtained. Licensee stated they did not obtain permits for the changes completed in the home.

The following type 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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/26/2024 03:34 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 07/26/2024 at 03:19 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: GONZALEZ, ARCELIA
FACILITY NUMBER: 434412779

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2024
Section Cited
CCR
102416.3(a)(2)

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Room additions to the family child care home.
This requirement was not met as evidenced by Licensee states her husband split a bedroom by adding a wall to make one room into two and failed to notify the Department of changes to the home. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Licensee will submit updated facility sketch to CCLD by POC date. LPA advised licensee and new fire clearance will be required.
Type B
08/09/2024
Section Cited
CCR
102416.3(b)

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The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.
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Licensee will contact the city to obtain building permit to changes in the home and provide proof to CCLD by POC date.
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This requirement was not met as evidenced by Licensee stated they did not obtain permits for the changes completed in the home. 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024


LIC809 (FAS) - (06/04)
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