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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421085
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:47:41 AM

Document Has Been Signed on 05/12/2023 10:47 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PUGA, JAIME & ALESSANDRAFACILITY NUMBER:
013421085
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Alessandra & Jaime PugaTIME COMPLETED:
11:05 AM
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On May 12, 2023 at approximately 9:35 AM, Licensing Program Analyst (LPA) Elimika Woods met with Alessandra & Jaime Puga for an ANNOUNCED CASE MANAGEMENT CAPACITY INCREASE INSPECTION. Also present for this visit was the licensee's fingerprint cleared assistant, I. Zamora two preschool age children and two infants. Licensee stated that the facility operates from Monday to Friday 7:45 AM to 5:30 PM.

The home was toured to conduct a Health and Safety Inspection. There are no changes to the home since the last inspection visit on 10/12/22. The on limits area consist of the living and dining room, kitchen, day-care room, bedroom on the right side of the hallway, backyard, and the bathroom near the day-care room. The off-limits areas is the master bedroom, bedroom to the right of hallway bathroom, bathroom in hallway near master bedroom, In law unit in the backyard, and two sheds in the backyard. Per licensee, there are firearms stored at this facility in an off-limits area inaccessible to children in care. The firearms were verified by the LPA.

The OUTDOOR PLAY area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. There's two sheds with locks to prevent children access to equipment and a In-law unit that is off-limits to children in care. LPA did not observe any hazardous materials or toxins accessible to children today.

LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Hayward Fire Department dated 4/28/2023. There were no deficiencies cited during this visit.

Based on the approval of the fire clearance, issuance of license for capacity change is recommended for this home effective today 5/12/2023. Exit interview was conducted with licensee, Alessandra & Jaime Puga. A copy of this report was issued to licensee and is to remain in the facility records for a period of 3 years.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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