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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421174
Report Date: 10/19/2022
Date Signed: 10/19/2022 09:14:45 AM

Document Has Been Signed on 10/19/2022 09:14 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:SANCHEZ, ROSALBA & ERWINFACILITY NUMBER:
013421174
ADMINISTRATOR:SANCHEZ, ROSALBA & ERWINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 243-5693
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Rosalba SanchezTIME COMPLETED:
09:25 AM
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On October 19, 2022, Licensing Program Analyst (LPA) Simerjit Kaur conducted an unannounced Case Management inspection. LPA met with licensee Rosalba Sanchez for deficiency that were issued on 10/14/2022 during the case management inspection.

Upon initial arrival there 6 children, which consisted of 3 infant age and 3 preschool age children. Present during the inspection, 1 child infant age child, 1 preschool age child and assistant Joana Cervantesarteag arrived. Licensee stated that 9 children are enrolled, which consist of 4 infant age and 5 preschool age. LPA obtained a copy of facility roster.

LPA Kaur cleared deficiency and provided licensees 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 Rosalba Sanchez.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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