<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304205207
Report Date: 01/05/2024
Date Signed: 01/05/2024 01:41:45 PM

Document Has Been Signed on 01/05/2024 01:41 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SILVEIRA, MONICAFACILITY NUMBER:
304205207
ADMINISTRATOR:SILVEIRA, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 403-7399
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Niklas SilveiraTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LicenPA Tran conducted a random unannounced visit with attempt to do a 3-year required annual inspection. LPA met with Adult #1 (A1). A1 informed LPA Tran that Licensee was out of town and will return on Monday 01/08/2024. LPA observed A1 was providing care for 3 preschool children.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA spoke with Licensee Monica Silveira over the phone. Licensee said she was out of town today and had made an arrangement for a qualified substitute adult to provide care for the children temporarily until the Licensee return on Monday 01/08/2024. Licensee requested for the Annual inspection to be conducted when Licensee is present on another date.

LPA reviewed record of A1, who has received criminal record clearances, TB clearances, current Pediatric CPR/First Aid (expires on 06/2024), current Mandated Report training certificate (expired on 09/2025). A1 is verified a qualified substitute adult.

No violation of Title 22 during today's visit.

Appeal Rights were explained. The facility representative was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Adult #1.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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 1