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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417689
Report Date: 07/10/2024
Date Signed: 07/10/2024 10:56:33 AM

Document Has Been Signed on 07/10/2024 10:56 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 CASTILLO, LORENAFACILITY NUMBER:
274417689
ADMINISTRATOR/
DIRECTOR:		LORENA ALVAREZ CASTILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 431-9506
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lorena Alvarez CastilloTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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July 10th 2024 Licensing Program Analysts (LPAs), Andrea Cortez and Fermin Campos-Jaramillo met with Licensee, Lorena Alvarez Castillo for a case management inspection. Licensee was unable to provide to LPAs with a current roster. LPAs required file for child (ch 1) to review, the licensee was unable to provide.
Exit interview was conducted and report was reviewed in Spanish with the licensee Lorena Alvarez Castillo.

2 type B deficiencies were cited see (Lic809D)


Failure to comply with the Plan Of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day per each deficiency.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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 2
Document Has Been Signed on 07/10/2024 10:56 AM - It Cannot Be Edited


Created By: Andrea Cortez On 07/10/2024 at 10:10 AM
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 CASTILLO, LORENA
FACILITY NUMBER: 274417689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2024
Section Cited
HSC
1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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Licensee shall submit to Licensee Program a copy of the current and complete childrens roster by the POC date on or before 7/24/24
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Based on insepection the licensees did not comply with the section mentioned above. Licensee was unable to present a current roster. Which poses a potential health and safety risk to persons in care.
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Type B
07/24/2024
Section Cited
CCR102421(a)(1)

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The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child.
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Licensee shall submit to Licensee Program a copy of the current and complete childrens enrollment forms by the POC date on or before 7/24/24
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Based on insepection the licensees did not comply with the section mentioned above. Licensee was unable to present child records for (ch1). Which poses a potential health and safety risk to persons 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Andrea Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2