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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412850
Report Date: 07/19/2024
Date Signed: 11/14/2024 03:26:02 PM

Document Has Been Signed on 11/14/2024 03:26 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:IBARRA, ROCIOFACILITY NUMBER:
434412850
ADMINISTRATOR/
DIRECTOR:		IBARRA, ROCIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 251-2084
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 8DATE:
07/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Cristina Ruvalcaba MurilloTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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This is an Amended Report for report dated 07/19/2024

Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Assistant Cristina Ruvalcaba Murillo and explained the reason for the inspection. The purpose of this inspection is to discuss requirements for Licensee to be present at the home, stairs, and alteration to home.

Assistant stated that Licensee is currently out of town. Licensee left on 07/16/2024 and will be returning on 07/22/2024. LPA discussed with Assistant and Licensee via phone that she cannot be absent more than 20 percent of the hours that the facility is providing care per day.

LPA observed that Licensee is using the upper area in her backyard for the children, which has stairs that lead up. There is a gate at the top of the play area, but not at the bottom. LPA discussed with Licensee that the bottom of her stairs also needs to be barricaded. Assistant barricaded stairs during inspection.

Licensee stated that she submit the final permit for the converted garage to LPA Chin; however, there is nothing in the file. She stated that she will submit permit to Licensing.

Licensee will submit the following:
- final permit from the City for the converted garage by 07/26/2024
- written statement that Licensee understands that she cannot be absent more than 20 percent of the hours the family child care home (FCCH) is providing care per day

A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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Document Has Been Signed on 07/19/2024 12:15 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/19/2024 at 11:34 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: IBARRA, ROCIO
FACILITY NUMBER: 434412850

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/26/2024
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home. ...Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
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By POC 07/26/2024, Licensee will submit written statement acknowleding that she cannot be absent for more than 20 percent of the hours
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Based on interview, Licensee has been out of town since 07/16/2024 and will be returning on 07/22/2024. This poses a potential health and safety risk to children in care.
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that the faciltiy is providing care per day and plans for if she needs to be absent.

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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024


LIC809 (FAS) - (06/04)
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