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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412831
Report Date: 10/18/2022
Date Signed: 10/18/2022 09:24:14 AM

Document Has Been Signed on 10/18/2022 09:24 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GUERRERO, CORINAFACILITY NUMBER:
013412831
ADMINISTRATOR:GUERRERO, CORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 728-1027
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Corina GuerreroTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst Sidney Cortez met with licensee Corina Guerrero for an unannounced Case Management visit for clearing POC. Present during this inspection was Licensee and assistant supervising 2 infants and 2 preschoolers. Licensee is within the capacity ratio during today's inspection.LPA reviewed the roster and obtained a copy. LPA cleared deficiency cited over Reporting Requirements.

There are no deficiencies cited today. Copy of Cleared POC letters were provided



An exit interview was conducted with licensee, Corina Guerrero. A notice of site visit was posted. Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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 10/18/2022 09:24 AM - It Cannot Be Edited


Created By: Sidney Cortez On 10/18/2022 at 08:25 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GUERRERO, CORINA
FACILITY NUMBER: 013412831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2022
Section Cited
HSC
102416.2(g)

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Reporting Requirements
In addition to the requirements of Health and Safety Code Section 1597.467(a), no later than the same business day, the licensee shall notify a child's parent or authorized representative of the events to be reported to the Department pursuant to Sections 102416.2(b) and (c) that affect that child.



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POC was cleared on today’s visit

Licensee will review Reporting Requirements and Regulations. Compile acknowledgement letters from parents. Train staff and assistants regarding Reporting Requirement





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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:Wynn Norona
LICENSING EVALUATOR NAME:Sidney Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022


LIC809 (FAS) - (06/04)
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