013417591-2-7-2020-02-CC-BNEN-BLKS8M-20200207123922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417591
Report Date: 02/07/2020
Date Signed: 02/07/2020 12:39:26 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ROJAS, MARIA B.		FACILITY NUMBER:	013417591
ADMINISTRATOR:	ROJAS, MARIA B.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 652-2761
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94703
CAPACITY:	14	CENSUS: 9	DATE:	02/07/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Licensee Maria Rojas		TIME COMPLETED:	01:30 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 02/07/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced visit for the purpose of conducting a required annual inspection. LPA was met by licensee Maria Rojas. Present for the visit was four infants and five preschoolers and the licensee's assistant M. Catalinas. The home was toured to conduct a health and safety inspection. The licensee lives in the lower unit, and part of the lower unit and the separate in-law unit are used for the child care. The lower unit consists of the family room, kitchenette and dining area, 3 bedrooms, 2 bathrooms, laundry room and covered patio. The on limit areas include the family room, kitchenette and dining area, first bedroom on the left, the first bathroom on the left, and covered patio. The off limit areas include the two rear bedrooms and rear bathroom. These areas are made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area is the first bedroom on the left. The in-law unit consists of the play room, kitchenette, and bathroom. All of these areas are used for the child care. The outdoor play area is the fenced backyard, which is free from defects or dangerous conditions. There is a locked shed in the backyard, which is inaccessible to children. There are ample age appropriate toys and activities which are safe and appear to be in good condition. LPA observed that the wall heater is blocked to prevent access by children. There is a fully charged 2A10BC fire extinguisher in the lower level of the home, and in the in-law unit. Fire and Disaster Drills have been being conducted with the last one being 01/06/2020. CPR and First Aid is current and expiring 07/20. LPA reviewed children files which were found in compliance. There is a functioning combination smoke/carbon monoxide detector and telephone. There is a fully stocked first aid kit. Per the licensee, there are no firearms in the home. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROJAS, MARIA B.	FACILITY NUMBER: 013417591
	VISIT DATE: 02/07/2020

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must be submitted to the Department. Currently, the licensee has no kids in care requiring medicine. 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 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. Licensee was reminded of the responsibility as a mandated reporter and the requirement to complete it every 2 years.

A child care roster was obtained. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices, policy, and consulted with Licensee to answer questions.

No deficiencies observed at this visit. A Notice of Site visit was given and facility was reminded that it is required to be posted for 30 days. Exit interview conducted, appeal rights provided, and a copy of this report was left with licensee Maria Rojas.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

LIC809 (FAS) - (06/04)

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