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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414420
Report Date: 03/17/2025
Date Signed: 03/20/2025 09:35:00 AM

Document Has Been Signed on 03/20/2025 09:35 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ALVAREZ, MAYRAFACILITY NUMBER:
274414420
ADMINISTRATOR/
DIRECTOR:
ALVAREZ, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 536-5768
CITY:ROYAL OAKSSTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
03/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Mayra AlvarezTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On March 17, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced annual random inspection. The purpose was explained to the licensee, who granted access. and received the Entrance Checklist (LIC 126).

The facility operates Monday through Friday, 6:00 a.m. to 5:00pm, Saturday 6:00am to 2:30pm. Required postings were visible, and the last fire/disaster drill was on 1/14/2025 The licensee was reminded of the six-month drill and documentation requirement.

Licensee, Assistant Jimmy Fernandez and one pre-schooler, meeting capacity and ratio requirements. The licensee was reminded of supervision, reporting obligations, and that children’s rights cannot be waived.

All adults 18 and older associated with the facility, including residents and volunteers, have fingerprint clearances.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALVAREZ, MAYRA
FACILITY NUMBER: 274414420
VISIT DATE: 03/17/2025
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LPA toured the facility, indoor off-limit areas include master bedroom, master bathroom, attached garage and 2 other bedrooms.Outdoor Off limit areas include storage building and all area outside of fenced in area for children.

Observations included a fully charged 3A-40B-C fire extinguisher, last serviced 9/4/2025, working smoke and carbon monoxide detectors, and a working telephone. The home was clean, well-ventilated, and stocked with safe, age-appropriate toys. . All poisons, detergents, cleaning compounds, medicines were stored out of children’s reach. There is a gas fireplace in the living room that is barricaded safe for children

The fenced backyard contained age-appropriate, well-maintained equipment, including a play kitchen, sandbox, and play table. No bodies of water observed.

Smoking, baby walkers, bouncers, jumpers and similar items are prohibited in the daycare. The licensee confirmed no guns or ammunition are in the home. The licensee was reminded to notify licensing before making any changes to the house or yard.

Licensee’s CPR/First Aid certification expires on 10/25/2026. The preventive health certification is on file, and mandated reporter training expires on 9/14/2025. Assistant Jimmy Fernandez CPR/First Aid certification expires on 10/25/26. Preventative health certification is on file, and mandated reporter training expires 9/5/26.LPA reminded the licensee of the two-year renewal requirement.

The facility roster and five children’s files were reviewed, confirming all required forms were complete. Licensee provided proof of certificate of liability Insurance that includes coverage for up to 14 children in care at one time that expires 5/23/2025.

Children showing signs of illness must be separated from others until the parent or guardian arrives.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALVAREZ, MAYRA
FACILITY NUMBER: 274414420
VISIT DATE: 03/17/2025
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The licensee does not transport children but was reminded that should she decide to transport that a valid driver’s license is required to transport children. LPA also reminded the licensee that children cannot be left unattended in vehicles and that car seats and booster seats must be available for safe transportation

Safe Sleep Information was provided and licensee was reminded that an Individual Infant Sleeping Plan (LIC 9227) is a required for each infant up to 12 months old, with nap checks documented until age two. Cribs and play yards must be free of loose items, bumper pads, and hanging objects and mattresses must be firm, properly fitted, and have fitted sheets.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.



Licensee was reminded Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, inspection the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (8004314-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALVAREZ, MAYRA
FACILITY NUMBER: 274414420
VISIT DATE: 03/17/2025
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Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Licensee confirmed no Registered Sex Offenders reside at the facility. The LPA completed the RSO profile in FAS on 2/21/25. A search of the California Attorney General-Megan’s Law website found no registered sex offenders at the facility address.

No deficiency issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Appeals rights provided

Exit interview conducted and report was reviewed with the Licensee, Mayra Alvarez
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC809 (FAS) - (06/04)
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