Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415784
Report Date: 09/04/2019
Date Signed: 09/04/2019 11:30:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HEREDIA ANTON, MARIA & INFANTE LOPEZ, KARLAFACILITY NUMBER:
434415784
ADMINISTRATOR:HEREDIA ANTON, MARIA & INFFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 630-9036
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:14CENSUS: 13DATE:
09/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karla Infante LopezTIME COMPLETED:
11:30 AM
NARRATIVE
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LPA Dayna Collier met with licensee Karla Infante Lopez for a case management inspection. Today upon LPA's arrival, there were licensee, licensee's two assistants Katherine and Lineki and 13 preschool children in care. Also present for the inspection were applicant Mirtha Nostas, her two assistants Norma and Crystal and 6 children enrolled with her consisting of 4 infants and 2 preschoolers. Licensee was informed that she is operating out of compliance with her license.

The attached type A deficiency is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A site visit notice was posted by Licensee.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HEREDIA ANTON, MARIA & INFANTE LOPEZ, KARLA
FACILITY NUMBER: 434415784
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2019
Section Cited

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement is not met as evidenced by LPA's observation and interviews conducted.
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This poses an immediate risk to the health and safety of children in care.
TODAY LICENSEE IS CARING FOR 13 CHILDREN, NONE OF WHICH ARE SCHOOL AGE. IN ADDITION, THERE ARE 6 OTHER CHILDREN FROM THE UNLICENSED FACILITY NEXT DOOR WHO ARE PRESENT.
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2019
LIC809 (FAS) - (06/04)
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