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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414420
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:06:10 PM

Document Has Been Signed on 06/23/2022 03:06 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ALVAREZ, MAYRAFACILITY NUMBER:
274414420
ADMINISTRATOR:ALVAREZ, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 536-5768
CITY:ROYAL OAKSSTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Mayra AlvarezTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Mayra Alvarez, to follow-up on Fire Clearance for family child care home (FCCH). Upon arrival to the FCCH, LPA explained purpose of visit to Licensee and was admitted into the home. There were 5 children present, Licensee, and her adult son, Angel Fernandez, and LPA observed Licensee and her son moving all furniture from the garage to the living room.

During previous annual inspection conducted on 6/21/2022, Licensee was observed to be using the garage for day care. Fire clearance from Cal Fire- Monterey County conducted 5/27/2015 states that areas not approved for day care use are the bedrooms and garage in the home. Licensee presented LPA with Fire Clearance also from Cal Fire- Monterey County with same information (Fire Marshal, date of inspection, clearance granted) except inclusion of areas not approved for day care. LPA reviewed Prelicensing Report dated 6/4/2015 which additionally noted that bedrooms and garage are not approved for day care use by LPA Janet Tse. Due to inconsistencies between LPA and Licensee Fire Clearances, LPA advised Licensee that she would contact the fire department for clarity and follow-up.

LPA spoke to Captain Joel Mendoza, who conducted original Fire Clearance inspection for large FCCH approval, and explained situation. Capt. Mendoza states that his copy of the Fire Clearance states that bedrooms and garage are not approved for day care use. Capt. Mendoza further states that in order to use the garage for day care use, it needs to be permitted by the county to become a habitable space, otherwise garage use is not permitted. LPA advised Licensee that if she wishes to utilize the garage for future day care use, it will require county permitting in addition to submitting new application for family day care home (LIC279) and updated facility sketch (LIC999A). Upon receipt of documents, a new fire clearance can be requested prior to garage use at the FCCH.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALVAREZ, MAYRA
FACILITY NUMBER: 274414420
VISIT DATE: 06/23/2022
NARRATIVE
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Licensee states that right now she is not planning to move forward with obtaining permits from the county as the process can be very long and time consuming, but will consider it in the future.

LPA provided Licensee with a copy of fire clearance with conditions (no bedrooms/garage) on it.

LPA advised Licensee that if she would like to change any areas of her home from off-limits to on-limits to submit updated facility sketch (LIC999A). LPA additionally advised Licensee on how to submit waiver request for fireplace located in on-limits area of the home.

Exit interview conducted and report reviewed with Licensee, Mayra Alvarez.

As a result of todays inspection, deficiencies have been cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/23/2022 03:06 PM - It Cannot Be Edited


Created By: Cortney Nelson On 06/23/2022 at 02:23 PM
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: ALVAREZ, MAYRA
FACILITY NUMBER: 274414420

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2022
Section Cited
HSC
1597.46(f)(3)

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1597.46 Large Family Day Care Homes (f)...these standards shall apply uniformly throughout the state and shall include.. (3) specifications as to the floor or floors on which day care shall be provided.

This requirement was not met as evidenced by:
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Licensee will immediately cease use of the garage for day care use and will submit photos by 6/27/22 of empty garage and furniture set up in the home for day care use. All furniture in the home will be out of the garage prior to providing care to children on Monday.
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The Licensee did not comply with Fire Clearance conditions and was observed to be using the garage for day care, however it is not approved for use, which poses a potential risk to the health, safety, and/or personal rights of children 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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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