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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416401
Report Date: 08/25/2021
Date Signed: 08/25/2021 10:49:34 AM

Document Has Been Signed on 08/25/2021 10:49 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:CASTANO, ANGIEFACILITY NUMBER:
434416401
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
08/25/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angie CastanoTIME COMPLETED:
11:00 AM
NARRATIVE
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On 08/25/2021 at 9:00 AM, Licensing Program Analyst (LPA), Susy Cervantes, met with licensee, Angie Castano, for a case management. Present were licensee and their assistant Diana with 6 children in care: 5 infants and 1 preschool, licensee was out of ratio during today's visit.

LPA reviewed the children's roster and took a picture. LPA confirmed the ages of the children present, 5 children were under the age of 2. LPA explained and provided to licensee a copy of the ratio and capacity for a small FCCH.

LPA conducted an exit interview with licensee in Spanish. LPA discussed the requirements of AB633 to Licensee, Angie Castano, and provided them the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Type A deficiency cited during today's visit. LPA provided appeal rights in English and Spanish to licensee. Notice of site visit with type A deficiency report must remain posted for 30 days
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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 08/25/2021 10:49 AM - It Cannot Be Edited


Created By: Susy Cervantes On 08/25/2021 at 10:20 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: CASTANO, ANGIE
FACILITY NUMBER: 434416401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2021
Section Cited
CCR
102416.5(b)

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102416.5(b) Staffing Ration and Capacity- For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time...
(1) Four infants; or
(2) Six children, no more than three of whom may be infants; or
(3) More than six and up to eight children, without an additional adult attendant... This requirement was not met as evidence by:
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Licensee will submit written statement of understanding the regulations for capacity and ratio for a small FCCH. Licensee will pause services for two infants until they are licensed for a large FCCH.
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Based on record review and observation: Present were licensee and their assistant Diana with 6 children in care: 5 infants and 1 preschool. This poses an immediate risk to the health and safety of the children in care.
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Written statement is due by close of business on 08/26/2021

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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:Mary Segura
LICENSING EVALUATOR NAME:Susy Cervantes
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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