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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417728
Report Date: 02/12/2024
Date Signed: 02/12/2024 02:40:51 PM

Document Has Been Signed on 02/12/2024 02:40 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:DELGADO HERNANDEZ, ROSALIAFACILITY NUMBER:
274417728
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
02/12/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rosalia Delgado HernandezTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Deanna Villagrana and Martha Jimenez-Villanueva met with licensee Rosalia Delgado Hernandez for a case management visit which licensee initiated. LPAs explained the nature of the visit. Present were licensee, licensee's adult daughter, adult son, 15 year old son and one day care child.

The department received an application for a large license on 12/07/2023. A fire clearance was approved on 01/31/2024. LPAs toured the indoor and outdoor areas of the home during today’s inspection. LPAs observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPAs observed a fully charged 3A40BC fire extinguisher, a working smoke and carbon monoxide detector, no bodies of water and a fenced backyard. Licensee states she has one dog that stays upstairs and is vaccinated. Off limits areas in the home are upstairs master bedroom/bath, three bedrooms, one bath and downstairs closets and attached garage. Licensee will use left side of yard for emergency exit and understands the exit must remain clear. LPAs discussed capacity and staff ratios with licensee and provided capacity chart.

Exit interview conducted and report was reviewed with Rosalia Delgado Hernandez. No Applicant was informed a large license is approved today.

No deficiency was cited.

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.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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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