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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418936
Report Date: 10/26/2022
Date Signed: 10/26/2022 01:31:49 PM

Document Has Been Signed on 10/26/2022 01:31 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BERRIOS, CLAUDIAFACILITY NUMBER:
013418936
ADMINISTRATOR:BERRIOS, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 245-9893
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
10/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Claudia BerriosTIME COMPLETED:
01:50 PM
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On October 26, 2022, Licensing Program Analyst (LPA) Simerjit Kaur conducted anUnannounced Case Management Inspection. LPA met with licensee Claudia Berrios for deficiency that were issued on 10/05/2022 during the required annual random inspection. Present during the inspection is Assistant Lilian Garrido and 7 children, which consisted of 4 infant age and 3 preschool age children.

LPA tour the backyard with licensee to place the backyard to on limit area of the home.
ON LIMIT AREAS (accessible to children in care): Kitchen, living room, dining room, day care room, bathroom located in day care room and backyard.
OFF LIMIT AREAS (not accessible to children in care): Master bedroom/bathroom, 2 bedrooms, and bathroom in hallway.
LPA reviewed children and staff files. LPA obtained a copy of facility roster. The backyard is placed on the on limit area of the home effective 10/26/22. Licensee conducted and documented fire/disaster drill on 10/6/22. Licensee maintains an Infant Sleep Plan for infants up to 12 months old and Sleep Log for upto 24 months old. LPA Kaur cleared deficiency and provided licensee with the Plan of Correction (POC) letter.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Claudia Berrios.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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