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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412902
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:12:40 AM


Document Has Been Signed on 05/10/2022 11:12 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GUZMAN, ROSARIOFACILITY NUMBER:
013412902
ADMINISTRATOR:ROSARIO GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 516-8261
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 0DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Rosario Guzman- LicenseeTIME COMPLETED:
11:25 AM
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On 05/10/22 at 10:26am, Licensing Program Analyst Briana Plumboy, met with licensee Rosario Guzman for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was fingerprint clear and associated adult J.Guzman. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 6:00am until 6:00pm, and per licensee, she is flexible with the families.

The home is single story. The home has heating and ventilation for safety and comfort. The ON LIMIT AREAS are the hallway bathroom, living room, and enclosed day care room. The OFF LIMIT AREAS are the 3 bedrooms, family room, master bathroom, kitchen/dining room, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be an area located inside the day care room. The BACKYARD is completely fenced for for children's use. There are ample age appropriate toys that appear to be safe. There are no pools, hot tubs or any other bodies of water present in the on limits areas during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has a current CPR and First Aid certificate which expires 09/18/22. The licensee's mandated reporter training is complete and she received a certification of completion on 01/01/22. There are no heaters or fireplaces in the home. Per licensee, there are no firearms in the home. The licensee has not conducted or documented a fire and/or disaster drill due to not having children enrolled in the childcare at this time. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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: GUZMAN, ROSARIO
FACILITY NUMBER: 013412902
VISIT DATE: 05/10/2022
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Rosario Guzman and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Rosario Guzman of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Rosario Guzman.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC809 (FAS) - (06/04)
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