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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408937
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:13:31 PM

Document Has Been Signed on 09/22/2022 02:13 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MY SPANISH VILLAGE IIFACILITY NUMBER:
073408937
ADMINISTRATOR:PEREZ, GLADYSFACILITY TYPE:
850
ADDRESS:1601 MARY DRIVETELEPHONE:
(925) 286-4382
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 16DATE:
09/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Gladys PerezTIME COMPLETED:
12:55 PM
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A case management visit was conducted today by Licensing Program Analysts (LPAs), Melissa Domantay and Melissa Guirit. LPAs met with Licensee Gladys Perez due to temporary fire clearance which was received for facility.

A fire clearance was received by the Contra Costa County Fire Protection Department for preschool children ages, 2 years to first grade entry and (14) school age children 4.9 years to 12 years on 9/8/2022.

A temporary preschool license will be made part of the license, effective 9/12/22-12/12/22 and can be used when the facility is ready, with an occupancy limit of 30 children for the whole facility. LPAs reminded Licensee the total number of preschool and school age children should equal to 30 children. There are no deficiencies being cited today. A Notice of Site inspection was provided to Licensee Gladys and an exit interview was conducted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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