Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304300987
Report Date: 06/19/2015 12:00:00 AM
Date Signed 06/19/2015 10:29:47 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALVARADO, MARIAFACILITY NUMBER:
304300987
ADMINISTRATOR:ALVARADO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 537-0305
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:14CENSUS: 6DATE:
06/19/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Maria Alvardo - LicenseeTIME COMPLETED:
10:30 AM
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LPA Jane Cong-Huyen met with licensee, Maria Alvarado, for a annual random visit using KIT2. LPA toured areas of the home inside and outside and areas accessible to the children. The home is a one level home with 4 bedrooms and 2 bathrooms. Licensee stated that OFF LIMITS areas include: all bedrooms except for the first left bedroom, master bath, garage, both side yard areas, laundry room and backyard shed. Licensee acknowledged that children may never enter these off-limit areas. The census includes 5 daycare children with ages ranging from 6 months old to 8 years old. (2 infants, 3 toddlers and 1 school-age child) One child is the licensee's own grand child. Also present during today's visit was the licensee's brother/assistant and her mother. Both have been fingerprint cleared. A review of family member/staff records on this date indicates that all family members and/or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee stated there are no new residents in the home since licensed. Licensee stated that she is not registered with any Foster Care agency. Licensee was able to show proof of CPR (exp:4/11/17) and First Aid (exp: 4/11/17) that is EMSA certified for herself and her brother/assistant. LPA observed posted license, Parent's Rights and current disaster plan. LPA also reviewed children's records and children's roster. The home has no fireplace. Wall heaters are screened and met regulations. Licensee stated there are no weapons in the home. LPA observed all sharp utensils, hazardous chemicals and medication are stored up high or in latched/locked cabinet which is inaccessible to children in care. Fire extinguisher, smoke and carbon monoxide detectors meet regulations. Licensee must provide 100% visual supervision when the children are in an unfenced area. The home has no pets at this time. The home has no bodies of water.
No deficiency cited during today's visit.
Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. LPA informed the licensee of how to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov and/ or http://ccld.ca.gov/PG411.htm. This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jane Cong-HuyenTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2015
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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