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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415580
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:56:42 PM


Document Has Been Signed on 03/09/2022 01:56 PM - 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, SANDRAFACILITY NUMBER:
013415580
ADMINISTRATOR:GUZMAN, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 441-2059
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 11DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sandra Guzman- LicenseeTIME COMPLETED:
02:05 PM
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On 3/9/22, Licensing Program Analyst Briana Plumboy met with licensee Sandra Guzman for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was licensees assistant Edith Henriquez, 2 infants, 9 preschool age children, and licensee fingerprint clear and associated adult children Melissa and Mitchell Guzman. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00am until 5:30pm.
The home is a 2 stories. The home is neat and clean with heating and ventilation for safety and comfort. The families enter the daycare through the gate located on the right side of the home. The ON LIMIT AREAS are the downstairs hallway bathroom, the bedroom located off the bathroom, the family room, the right side of the dining room, and the backyard. The OFF LIMIT AREAS are the living room, kitchen, the left side of the dining room, garage, downstairs bedroom, and entire second level which will be inaccessible by closed and/or locked doors and visual supervision. There are stairs located inside the home located inside the living room next to the front door. Per licensee, the children enter and exit through the family room and backyard, and at no time are near the stairs. The ISOLATION AREA will be the right side of the dining room. The BACKYARD play area is fenced. There are toys. There are no pools, hot tubs or any other bodies of water present at the facility during today's inspection. There is an anchored play structure located in the backyard and licensee is aware she must maintain the playstructure and follow all manufacture labels. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and pull down fire alarm. The licensee and assistant Edith's CPR and First Aid certificates are current and expire 06/23/23. The licensee and assistant Edith both recieved certificates in mandated reporter training, with licensee Sandra receiving her certificate on 4/26/20 and Edith recieved her certificate on 4/27/20. The licensee and assistant Edith Henriquez are in compliance with the immunization law. There are no fireplaces or wall heaters located inside the home. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 2/11/22.
At 12:37pm, (6) Children files were reviewed, facility roster reviewed and copy obtained. 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: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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, SANDRA
FACILITY NUMBER: 013415580
VISIT DATE: 03/09/2022
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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 Sandra 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 Sandra 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 Sandra Guzman.

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

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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