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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700326
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:16:04 PM

Document Has Been Signed on 02/09/2023 01:16 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:ALANIZ, GABRIELA & ROMERO CAMPOS, JORGEFACILITY NUMBER:
015700326
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Gabriela AlanizTIME COMPLETED:
12:45 PM
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 Licensing Program Analyst (LPA) Sidney Cortez mer with licensee Gabriela Alaniz to conduct an inspection.. The purpose of this inspection was to conduct an Annual Random Health and Safety Inspection. Licensee operates the facility Monday through Friday from 6:00am until 6:00pm. Present for this visit is the licensee and 3 infants.


The home is 1 story. The home consists of 4 bedrooms, 1 bathroom, living room, dining room, kitchen, backyard and garage The home is neat and clean with heating and ventilation for safety and comfort. There is no pool or any type of bodies of water in the home. Per licensee and visually confirmed by LPA Cortez there is no fire-arm in the house. The OFF LIMIT AREAS is the 3 bedrooms, storage on the backyard and the garage.
The ON LIMIT AREAS are the living room, dining room, family room, bathroom, and one bedroom and the backyard for play area. The ISOLATION AREA is the bedroom that is on limits
There are toys and learning materials in the activity room area.
Hazardous materials and toxins are kept out of the reach of children.


The home has one fully charged fire extinguisher (model 2A10BC), and working smoke/carbon monoxide detectors, first aid kit, emergency supplies, and working telephone. Licensee’s CPR and First Aid certificates are current and both certificates will expire on April 2024. Licensee received a certificate in mandated reporter training on 3/3/2022 which is valid for 2 years.


The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on Dec 8th, 2022. 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: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALANIZ, GABRIELA & ROMERO CAMPOS, JORGE
FACILITY NUMBER: 015700326
VISIT DATE: 02/09/2023
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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov


There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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