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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416841
Report Date: 11/20/2023
Date Signed: 11/20/2023 01:39:53 PM

Document Has Been Signed on 11/20/2023 01:39 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:RUBALCABA PEREZ, MAGDAFACILITY NUMBER:
444416841
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Magda "Nallely" RuvalcabaTIME COMPLETED:
01:49 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Applicant, Magda "Nallely" Ruvalcaba, to follow-up on corrections requested during pre-licensing visit on 11/7/2023. Upon arrival, LPA was admitted into the home by the Applicant.

LPA observed all required postings are hung on the front door of the family child care home (FCCH). The Applicant states that she plans to laminate the required posting documents and will hang them above the cubbies located outside the front door.

The water fountain outside has been unplugged and the Applicant states that it will only be used on the weekends or when day care children are not present. LPA advised that the water fountain must be emptied of any remaining water and shall be checked after rainy weather to confirm no standing water is present. LPA additionally advised covering the water fountain with a weather proof cover to prevent water from collecting in the fountain.

LPA observed the fireplace located in the living room is now properly screened. LPA reminded that the fireplace shall not be used during day care hours and shall be cool to the touch while children are present. The Applicant ordered six (6) nap cots and sixteen (16) sheets to be used. The sheets have already been delivered and the cots are expected to arrive on Wednesday (11/22). LPA reminded that infant sheets shall be washed daily and children's sheets shall be washed at least weekly.

The Applicant has changed the on/off-limits areas inside the home as LPA advised that a garage is not allowed to be used for day care. Off-limits inside of the home is revised to: master bedroom, master bathroom, and laundry room. LPA observed the staircase is properly barricaded from the top and bottom. The Applicant states that she will use upstairs and downstairs throughout the day with day care children and plans to have nap time upstairs. LPA observed there are sufficient toys and play equipment for the children. LPA obtained an updated facility sketch (LIC999A) from the Applicant for changes to the second floor and the garage.

Exit interview conducted and report was reviewed with the Applicant, Magda "Nallely" Ruvalcaba.

LPA advised the Applicant that a small FCCH license will be issued pending manager review and approval.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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