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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413163
Report Date: 02/26/2025
Date Signed: 02/26/2025 12:39:27 PM

Document Has Been Signed on 02/26/2025 12:39 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BECERRA, DIANAFACILITY NUMBER:
274413163
ADMINISTRATOR/
DIRECTOR:		BECERRA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 710-9742
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Diana BecerraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted unannounced Case Management inspection and met with Licensee Diana Becerra. Purpose of today's inspection discuss an unusual incident report that Licensee, Diana Becerra self reported to the Department on February 24, 2025.

LPA obtained copies of pertinent information and conducted interview during today's visit.
On 2/21/2025 child (C1) went to an off limit area that resulted in child (C-1) sustaining an injury. Licensee immediately attended to child (C1) and preformed first aid and redirected child back to within limit area.

The following "Type B" deficiency was cited and is noted on the attached page (LIC 809-D)

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/26/2025 12:39 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 02/26/2025 at 11:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BECERRA, DIANA
FACILITY NUMBER: 274413163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/05/2025
Section Cited
CCR
102423(a)(2)

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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:
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Licensee agreed to submit a written Plan of Correction (POC) to LPA indicating what steps will be implemented to ensure that the day care children don't have access to off limit areas and are supervised at all times by POC due date.
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On 2/21/2025 child (C1) went to an off limit area that resulted in child (C-1) sustaining an injury. Licensee immediately attended to child (C1) and preformed first aid and redirected child back to within limit area which poses/posed a potential health, safety or personal rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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