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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417462
Report Date: 04/17/2026
Date Signed: 04/17/2026 12:23:35 PM

Document Has Been Signed on 04/17/2026 12:23 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:JUAREZ AYALA, MARISOLFACILITY NUMBER:
274417462
ADMINISTRATOR/
DIRECTOR:		MARISOL JUAREZ AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 794-9718
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 1DATE:
04/17/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Marisol Juarez Ayala TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 04/17/2026, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee Marisol Juarez Ayala for an unannounced annual/random inspection and a case management and explained the reason for the visit to her. At arrival licensee was not at home, assistant Azucena granted access to the home, licensee arrived 10 minutes later. No children in care at home only her own child. Licensee stated only herself as adult and her four children living in the home, aged: 17-, 12 (twins)- and 7-year-old. All required posting materials were posted. Days and hours of operation are Monday to Saturday from 5:00AM to 5:00 PM. Licensee carries day-care insurance with Markel Insurance Co. and its current.

The FDCH is requesting to open the dining room as on-limits area, which was previously off-limits and a Fire Inspection clearance was required. Fire Inspection was granted on 3/19/2026 by the Greenfield Fire Protection District with no special conditions. The following areas are approved for childcare according to the Fire Inspection document: living and dining room, one bathroom, half of backyard (wood fenced). Licensee understands the on-limits and off-limits areas have been approved by the Fire District Authority and before making any changes to the use of the areas Licensee will notify the Licensing Program.

LPA toured the indoor/outdoor areas during today's visit. LPA observed barricaded stairs, no fireplace and no wall heater inside the home. Off limits areas inside the home: barricaded kitchen, the entire second floor including master bedroom/bath, two bedrooms, one bath and laundry area. Off limits areas outside the home: front yard, detached garage, and the half back yard. LPA observed pets in the home, one rabbit in the master bedroom (upstairs) and two dogs in the half backyard. LPA reviewed vaccinations records and are current.
Report continues in next pages.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: JUAREZ AYALA, MARISOL
FACILITY NUMBER: 274417462
VISIT DATE: 04/17/2026
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LPA observed a fully charged fire extinguisher 3A40BC that was serviced on 03/30/2026, functioning smoke detector and carbon monoxide (CO) detector and a fire/disaster drill log was conducted on 01/23/2026. LPA did not observe bodies of water. Licensee stated there are no weapons/ammunition in the home.

The home is clean, orderly, including central heater and a/c system for safety and comfort for children in care. Cleaning products, medications, sharp objects, and other items that are dangerous to children were stored inaccessible in top laundry room cabinet, in top kitchen cabinets. LPA observed sufficient age-appropriate materials, toys, and play equipment indoors and outdoors areas. The children's bathroom is clean, sanitary, and operable. The home has a working telephone. Licensee stated that a child will be isolated in a chair close to entrance door in the hallway, if necessary, due to illness or communicable disease. Licensee stated that she transports day care children. Licensee understands that children shall not be left unattended in parked vehicles must use appropriate car seats according to the child's age/weight/size and car seat cannot be used for sleeping. LPA reviewed and obtained copy of DL, car insurance and registration, documents are current.

LPA obtained a copy of current children's roster. LPA reviewed five (5) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Immunization Record (CDPH 286), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance for FCCH (LIC 282), Infant Sleep Log (LIC 9227), sleep log (for children 0-24 months), and Immunization Records. All required forms are on file.

LPA reviewed licensee’s and two assistant’s files. Licensee and assistants have current Pediatric CPR/First Aid certifications with an expiration date of 02/01/2027, 03/01/2028 and 02/2027. Mandated Reporter Training was completed on 02/23/2025, 03/05/2026 and 08/13/2024. Needed documentation for SB 792 which requires against Pertussis, Measles, and Influenza as well as TB testing are on file for the three of them. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

Continuation in next pages.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
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: JUAREZ AYALA, MARISOL
FACILITY NUMBER: 274417462
VISIT DATE: 04/17/2026
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No children were present since children in care are attending school at the time of the inspection. LPA went over substitute options and reminded the licensee they could only have 14 according to their license and she understands that she must be present in the home during day care hours (80% of the operating hours) and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options.

Roster Report was reviewed on 04/16/2026. It indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee informed her son has live scan appointment on 04/21/2026. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 is not providing Incidental Medical Services at this moment. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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 visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Report continues in next page.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: JUAREZ AYALA, MARISOL
FACILITY NUMBER: 274417462
VISIT DATE: 04/17/2026
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Marisol Juarez Ayala confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



No deficiencies were cited during today's visit. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Marisol Juarez Ayala in Spanish.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC809 (FAS) - (06/04)
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