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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409084
Report Date: 02/03/2022
Date Signed: 03/07/2022 09:47:16 AM

Document Has Been Signed on 03/07/2022 09:47 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PULIDO, MAYRAFACILITY NUMBER:
073409084
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mayra PulidoTIME COMPLETED:
11:30 AM
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On 2/3/22 at 11:00AM Licensing Program Manager (LPM) Sherelle Johnson and Licensing Program Analyst (LPA) Michelle Sutton conducted an informal meeting with Mayra Pulido via Zoom in English. An in-person meeting was not held due to the COVID-19 pandemic. Present during today's meeting (LPA) Michelle Sutton, (LPM) Sherelle Johnson and (Licensee) Mayra Pulido. The purpose of today's meeting for a Pending Change of Capacity application.

This facility was cited cited Type A on 10/14/21 for 102416.5(b)(3)(a) Staffing Ratio and Capacity For a Small Family Child Care Home where LPA observed 2 infants and 5 preschoolers in care. On 10/7/21 facility cited Type A 102416(d)(1) Personnel Requirements, where adult present in the home was not associated to the facility and per licensee did not have a criminal record clearance. Cited Type B for 102417(8) Operation of a Family Child Care home, Licensee did not have a roster readily available to LPA during visit. Cited Type A: 10216.5(a) Staffing Ratio and Capacity, LPA observed 9 children in care and Type A 102416.5(b)(3)(b) Staffing Ratio and Capacity, where LPA observed 3 infants and 6 preschoolers in care.

During the meeting a plan was discussed to ensure the facility is in compliance. It was agreed upon that LPA Michelle Sutton will conduct 2 visits within February and March. Licensee stated that she was unaware of licensing ratios and was not aware a person who does not have a green card can get fingerprinted. LPA plans to go over licensing forms and requirements with Licensee during visit.

Report was reviewed with Mayra Pulido
Report was emailed to the licensee. Licensee agrees to sign and return the report to CCL by 2/3/22
See original signature in file.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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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