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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414530
Report Date: 08/15/2022
Date Signed: 08/15/2022 01:28:32 PM

Document Has Been Signed on 08/15/2022 01:28 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:RIOS-GUZMAN, DULCE MARIAFACILITY NUMBER:
274414530
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
08/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Dulce Maria Rios-GuzmanTIME COMPLETED:
01:40 PM
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On 08/15/2022 at 12:50 PM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee, Dulce Maria Rios-Guzman for a case management to increase capacity. Present were licensee and their sons only. Previous to today's visit, LPA received a Fire Clearance from the Greenfield Fire Protection, inspection was conducted on 08/09/2022.

An annual inspection was conducted on 05/23/2022, no deficiencies were cited during the visit. LPA inspected the second exit for the home. LPA observed a 2A10BC fire extinguisher that was serviced on 05/09/2022, smoke detector and carbon monoxide detectors were operable. Licensee has current CPR and first aid that expires on 10/17/2022. Mandated Reporter training is current and was taken on 01/22/2021. LPA observed a blocked fireplace, gated stairs, no wall heater and no bodies of water. Licensee stated there are no weapons in the home. Licensee stated there are dogs and they are vaccinated. LPA observed there are no restrictions stated on the fire clearance. LPA reviewed with licensee their ratio/capacity for a large FCCH as well as assistant requirement.

No deficiencies were cited during today's visit. Exit interview was conducted and report was reviewed in Spanish with Licensee, Dulce Maria Rios-Gusman. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. A notice of site visit was given and must remain posted for 30 days.

LPA informed licensee that an increase of capacity to a large family child care home is approved pending the following:

-Management's approval

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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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