013412831-12-5-2019-52-CC-EWOS-BJKSQQ-20191205130508

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412831
Report Date: 12/05/2019
Date Signed: 12/05/2019 01:05:14 PM

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:	GUERRERO, CORINA		FACILITY NUMBER:	013412831
ADMINISTRATOR:	GUERRERO, CORINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 728-1027
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	14	CENSUS: 4	DATE:	12/05/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Corina Guerrero		TIME COMPLETED:	01:15 PM

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 12/05/2019, at approximately 12:00 PM, Licensing Program Analyst Elimika Woods (LPA) and Licensing Program Analyst Briana Plumboy (LPA) met with licensee Corina Guerrero, to conduct an unannounced Annual/Required Inspection. Present during the inspection was assistant Ana Martinez, three preschool age children, one infant, and fingerprint cleared and associated husband Jose Guerrero. Also present was licensees son Omar Gonzaelez who licensee stated was visiting to help put up Christmas decorations. LPA Woods conducted a Health and Safety Inspection with the licensee. Licensee states her hours of operation are from 6:00 AM to 7:00 PM., Monday through Friday. On-limit: Daycare room, kitchen, dining area, family room, bedroom, hallway bathroom, and the main part of back yard. As of 12/05/19, licensee is adding the first bedroom off the left of the bathroom onto the on limit areas. Off-limit: Off-limits will be made inaccessible by closed and/or locked doors and visual supervision The home is a single-story home, which is neat and clean with heating and ventilation for safety and comfort. The home consists of the four bedrooms, two baths, family room, dining area, kitchen, back and side yard, and garage. The Isolation Area will be in the living room area away from children in care. The Outside play area is fully fenced and available to children in care. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are toys and learning materials present during today's inspection. There is a hot tub which is currently empty of water and has locking safety latches. There are no other pools or accessible bodies of water. The home has a fully charged 4A80BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and First Aid Kit. Licensee's CPR and First Aid certificate is current and expires 02/2021. There are two fireplaces which are latched to prevent access by children. Per licensee, there are no firearms in the home. The licensee completed and received a certificate in mandated reporter training on 01/22/2018. Assistant Ana Martinez currently has a waiver in place for the mandated reporter training certificate. The licensee is in compliance with the immunization laws which pertains to all day care providers. The licensee conducts fire/disaster drills at least twice a year with the last drill conducted on 11/01/19. See 809 C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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: GUERRERO, CORINA	FACILITY NUMBER: 013412831
	VISIT DATE: 12/05/2019

NARRATIVE

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At 12:15 PM, LPA Woods requested to review two (2) children’s facility files. Each file contained completed identification & Emergency forms. Completed medical consent forms.

Incidental Medical Services (IMS) -Per the licensee, there are no children on any form of medication. The licensee is not providing IMS currently.

LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing and Smoking is prohibited in a Family Child Care home.

The licensee was 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. The licensee was reminded of the responsibility as a mandated reporter.

The licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and new car seat laws provided.

There were no deficiencies cited during this visit. A copy of the Notice of Site Visit was provided and is to remain posted for 30 days from this date. This report shall remain on file for 3 years. Exit interview conducted. Appeal rights provided.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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