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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417591
Report Date: 05/20/2022
Date Signed: 05/20/2022 01:33:36 PM


Document Has Been Signed on 05/20/2022 01:33 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ROJAS, MARIA B.FACILITY NUMBER:
013417591
ADMINISTRATOR:ROJAS, MARIA B.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 695-7111
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:14CENSUS: 7DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Maria RojasTIME COMPLETED:
01:45 PM
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On May 20, 2022, Licensing Program Analyst (LPA) Indira Loza 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 four preschoolers and the licensee's assistant is Luz Chavez. 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 in the-law unit. 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 3A10BC 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 01/18/22. CPR and First Aid is current and expiring 05/2024. LPA reviewed children files which were found in compliance.
There is a functioning smoke detector, a functioning carbon monoxide detector and telephone. Per the licensee, there are no firearms in the home.

All required forms are posted and visible for public view in the child care room. LPA obtained the children’s files, assistants file, and facility roster. All adults have obtained a criminal record clearance and all files were complete.



Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children
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SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ROJAS, MARIA B.
FACILITY NUMBER: 013417591
VISIT DATE: 05/20/2022
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in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

No children who need medication are present. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with Licensee 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 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. Exit interview conducted and report was reviewed with Licensee Rojas.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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