010208745-6-17-2019-52-CC-LDYN-BD8PK2-20190617112226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010208745
Report Date: 06/17/2019
Date Signed: 06/17/2019 11:22:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	TREJOS, LIDIETTE		FACILITY NUMBER:	010208745
ADMINISTRATOR:	TREJOS, LIDIETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 481-1976
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	12	CENSUS: 7	DATE:	06/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Lidiette Trejos		TIME COMPLETED:	11:32 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 6/17/19 at 9:50am Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensee. The licensee's fingerprint cleared daughter/assistant N. Trejos, 2 infants and 5 preschool age children were also present. At 10:00am LPA began a tour of the areas used for the child care, to conduct a health and safety inspection. The home is neat and clean with heating and ventilation for the safety and comfort of children in care. The children have access to the living room, dining room, and kitchen, but the main area for the child care is the child care room in the rear of the home and the bathroom in this room. The off limit areas include all other areas of the home, which are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be a section of the living room, away from other children in care. The outdoor play area is the fenced backyard, which is divided into two sections by a small fence. The area used for the child care is on the left side of the yard, and is free from defects or dangerous conditions. LPA observed an ample supply of toys and activities available to children, which are age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. The fireplace has a locked glass door to prevent access by children. There are no heaters accessible to children. The home has a fully charged 2A10BC fire extinguisher, working combination smoke/carbon monoxide detector, telephone and fully stocked first aid kit. Per the licensee, there are no firearms in the home. The licensee conducts and documents fire and earthquake drills at least twice a year, and the last drills were conducted on 1/14/19 and 2/15/19. The licensee's CPR/first aid certificates are current and expire on 2/10/20. At 10:43am LPA requested and reviewed the files of 3 children in care. The facility roster was reviewed and a copy obtained. LPA observed that all required forms are posted and visible for public review. Licensee was reminded of the responsibility as a mandated reporter. The licensee has a certificate of completion of the required mandated reporter training, which was completed on 10/30/18. continued on 809C

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TREJOS, LIDIETTE	FACILITY NUMBER: 010208745
	VISIT DATE: 06/17/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The licensee stated that there are no children enrolled at this time, who require medication while in care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019

LIC809 (FAS) - (06/04)

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