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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421517
Report Date: 07/02/2024
Date Signed: 07/02/2024 09:00:37 AM

Document Has Been Signed on 07/02/2024 09:00 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:MONTES, ROSIOFACILITY NUMBER:
013421517
ADMINISTRATOR/
DIRECTOR:		MONTES, ROSIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 862-6705
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:49 AM
MET WITH:Rosio MontesTIME VISIT/
INSPECTION COMPLETED:
12:02 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Rosio Montes for an Unannounced Annual Random Inspection. Present for this visit was the licensee Rosio Montes and 4 pre school age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:00AM until 5:00PM, Monday-Friday. "On Limit" Areas (accessible to children in care): Classroom/multipurpose room outside of kitchen): there are safe toys, play equipment and materials which appear age appropriate and adequate for the children in care. Restroom (one): available for children’s use. Backyard/Outdoor play area: Gate. 2 Bedrooms (Nap Area) and Isolation Room "Off Limit" Areas (not accessible to children in care): Master Bedroom. Private bathroom. Kitchen. Living room (fireplace non-operational). Backyard sheds. Garage. The Off limit areas are gated and children are supervised. The Isolation Area will be one of the bedrooms.

There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children. Per licensee, there are no firearms in the home.


The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit. the home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (April 2026). The licensee's mandated reporter training is current and expires (May 2026). Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on
June 2024. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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