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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415961
Report Date: 01/31/2023
Date Signed: 01/31/2023 10:33:56 AM

Document Has Been Signed on 01/31/2023 10:33 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LOERA GAETA, JULIAFACILITY NUMBER:
434415961
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 1DATE:
01/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Julia Loera GaetaTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Julia Loera Gaeta for a request of increase of capacity visit. Present were licensee, licensee's adult son and one day care infant. The adults that reside in the home are the licensee, licensee's husband, two adult sons and 12 year old daughter.

LPA toured the indoor and outdoor areas during today's visit. LPA did not observe a fireplace or stairs in the home. Off limit areas inside the home:Master bedroom/bath, two bedrooms, one bathroom and entry closet. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector and carbon monoxide, fenced backyard, and no bodies of water. Off limit areas outdoor: area that is fenced off to children including 5 storage. There is one cat in the home that stays in adult son's room.

LPA observed a current roster and reviewed one child's file. File is complete and child has current immunization records on file. LPA observed licensee has a current CPR and First Aid certification expiring 07/21/2024 and completed Mandated Reporter training on 08/23/2022. Licensee has current immunizations against pertussis, measles and influenza on file.

Exit interview conducted and report was reviewed with the licensee Julia Loera Gaeta. A fire clearance was approved on 01/27/2023 by Gilroy Fire Department. Licensee was informed a large day care is approved pending Manager's approval.

No deficiency was cited.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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