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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415983
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:12:49 AM

Document Has Been Signed on 06/13/2022 11:12 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CONTRERAS, ADELAFACILITY NUMBER:
274415983
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Adela ContrerasTIME COMPLETED:
11:20 AM
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On 06/13/2022 at 10:20 AM, Licensing Program Analyst (LPA) Susy Cervantes, met with licensee's daughter/assistant, Ana, for a case management visit to increase capacity and explained the reason for the visit to them. Present were assistant with 4 children in care: 1 infant and 3 preschool age. Shortly after arrival, licensee, Adela, arrived. Prior to today's visit, LPA had received a fire clearance from the Greenfield Fire Protection District, inspection was conducted on 05/31/2022.

An annual inspection was conducted on 04/21/2022, type B deficiencies were cited and have been cleared. LPA observed a new 3A40BC fire extinguisher that was serviced on 06/01/2022, smoke detector and carbon monoxide detectors were operable. Licensee has current CPR and first aid that expires on 12/01/2022. Mandated Reporter training is current and was taken on 11/09/2022. LPA observed covered fireplace, no stairs, no wall heater and no bodies of water. Licensee stated there are no weapons in the home. Licensee stated there is a pet and they are vaccinated. LPA reviewed the requirements stated on the fire clearance with licensee, Adela Contreras, including that the garage, laundry room, master bedroom, room 1, 2, and 3 are not approved for use. 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, Adela Contreras. 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: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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