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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417603
Report Date: 01/25/2023
Date Signed: 01/25/2023 02:02:06 PM

Document Has Been Signed on 01/25/2023 02:02 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:ROCHA ORTEGA, ANAFACILITY NUMBER:
434417603
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
01/25/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ana Rocha OrtegaTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Ana Rocha Ortega for a request of increase of capacity visit. Present were licensee and four day care children including one infant. The adults that reside in the home are the licensee, licensee's husband and their nine year old daughter.

LPA toured the indoor and outdoor areas during today's visit. LPA observed barricaded stairs in the home. Off limit areas inside the home: upstairs three bedrooms and one bath, downstairs attached garage and pantry closet. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector and carbon monoxide fenced, backyard, and no bodies of water. Off limit areas outdoor: two locked storages. The front yard and the back yard are joined together with a space to the left and is fenced off so children do not have access to the entire front yard.

LPA observed a current roster and reviewed four children's files. All files are complete and children have current immunization records on file. LPA observed licensee has a current CPR and First Aid certification expiring 10/01/2024 and completed Mandated Reporter training on 02/18/2022. Licensee has current immunizations against pertussis, measles and influenza on file.

Exit interview conducted and report was reviewed with the licensee Ana Rocha Ortega. A fire clearance was approved on 01/19/2023 by Gilroy Fire Department. Licensee was informed a large day care is approved pending Manager's approval.

No deficiency was cited.

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: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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