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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409250
Report Date: 04/03/2024
Date Signed: 04/03/2024 01:08:38 PM

Document Has Been Signed on 04/03/2024 01:08 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:AYALA, ANAFACILITY NUMBER:
073409250
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ana AyalaTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 4/3/24 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an unannounced Case Management inspection at Ana Ayala's family childcare home. Licensee has applied for CAPACITY INCREASE from 8 to 14 children. LPA met with Licensee, Ana and explained the purpose of inspection. Present in the home were Licensee, 1 Assistant and 6 day care children (1 infant, 2 school age child, 3 preschool age). Out of the 6 present, 2 were Licensee's grand children and 1 Assistant's child). Facility is in ratio compliance today. All adults have fingerprint clearances. Fire clearance was granted on 3/14/24 and Licensee has met all Fire Department requirements.

Licensee understands when providing care for more than 12, parents must be notified and Parent Notification for Additional Children in Care LIC9150 has to be maintained in child files. Licensee owns the home and does not need Landlord Consent. LPA explained the capacity and limitations and ratio requirements of a Large Family Childcare Home. If no Assistant is present at a Large Family Childcare Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home.
LPA inspected all areas of the home inside and outside.
IN USE AREAS: Living/Play Room, Hall Bathroom #1, Kitchen, Backyard, Front yard
OFF LIMIT AREAS: All 3 Bedrooms, Bathroom #2 inside bedroom, Laundry area, Hallway leading to the bedrooms (gated), attached Garage, Left Side yard, 2 outdoor storage sheds

All licensing documents and requirements are complete. Facility is approved for Large Childcare Home effective 4/3/24. Report was reviewed and exit interview conducted with Licensee, Ana Ayala. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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