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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300634
Report Date: 08/10/2023
Date Signed: 08/10/2023 10:04:34 AM

Document Has Been Signed on 08/10/2023 10:04 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VALLEJO FAMILY CHILD CAREFACILITY NUMBER:
376300634
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Blanca Vallejo-GonzalezTIME COMPLETED:
10:25 AM
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
On August 10, 2023 at 9:10 am, Licensing Program Analyst (LPA) Jessica Rubio arrived to the facility to conduct and case management visit to increase the license capacity from a small family child care home to a large family child care home. A fire clearance was granted for an increase of capacity on 7/17/2023 for the downstairs only. LPA met with licensee Blanca Vallejo-Gonzalez and toured the facility and the following was observed and/or discussed:
· Normal days and hours of operation are: Monday through Friday 7:00 am - 4:30 pm.

· Off-limit areas include: The entire second story, first floor bedroom and garage.

· All hazardous items are stored inaccessible to children

· Weapons are present and stored according to Title 22 Regulations. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs are barricaded

· Clean, safe, and age-appropriate toys are provided

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· No bodies of water are present at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Licensee's Pediatric CPR and First Aid Card expires on 3/2025

· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VALLEJO FAMILY CHILD CARE
FACILITY NUMBER: 376300634
VISIT DATE: 08/10/2023
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
26
27
28
29
30
31
32
Licensee was reminded that all adults 18 and over, living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Large Family Child Care Home License will be submitted for approval with a maximum capacity of 12, or 14 with parent notification.



An exit interview was conducted, and this report was reviewed with the licensee Blanca Vallejo-Gonzalez. Appeal rights were discussed and provided during the exit interview. A notice of site visit was emailed to licensee and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2