013414016-12-10-2019-02-CC-LDYN-BJQV38-20191210150418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414016
Report Date: 08/15/2019
Date Signed: 12/10/2019 03:04:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	LOPEZ, ROSA & ALEGRIA, ADAN		FACILITY NUMBER:	013414016
ADMINISTRATOR:	LOPEZ, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 261-2776
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	14	CENSUS: 14	DATE:	08/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Rosa Lopez		TIME COMPLETED:	04:30 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 8/15/19 at 2:20pm, Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with Rosa Lopez. There were 14 children present, and the licensee's fingerprint cleared assistant A. Alegria was also present. LPA conducted a tour of the areas of the home used for the child care. The home is a single story home with a storage room under the home. The home is neat and clean with sufficient heating and ventilation for the safety and comfort of children in care. The on limit areas include the living room, dining room, kitchen, 2 bedrooms on the left side, the child care room, the 2 rooms located next to the child care room, the bathroom in the child care room, and the bathroom in the backyard. All other areas of the home are off limit areas are made inaccessible by closed and/or locked doors and visual supervision. The first bedroom on the left or the living room, away from other children in care, will be used for isolation. The fenced backyard will be used for outdoor play, and LPA observed that it is free from defects or dangerous conditions. LPA observed an ample supply of toys and activities, which are age appropriate and appear to be in good condition, available for children. The heater vents and fireplace are blocked to prevent access by children. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, fully stocked first aid kit and telephone. Per the licensee, there are no firearms in the home. LPA reviewed children's files. The facility roster was reviewed, and a copy was obtained. 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.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LOPEZ, ROSA & ALEGRIA, ADAN	FACILITY NUMBER: 013414016
	VISIT DATE: 08/15/2019

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 reminded of the responsibility as a mandated reporter. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at mandatedreporterca.com. The licensee will try to take it, but may wait until it is offered in her primary language.

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 with the Ms. Rosa Lopez.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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