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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419077
Report Date: 01/24/2020
Date Signed: 01/24/2020 12:27:00 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:DELA CRUZ, ILUMINADAFACILITY NUMBER:
013419077
ADMINISTRATOR:DELA CRUZ, ILUMINADAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 523-4652
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 1DATE:
01/24/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Iluminada Dela CruzTIME COMPLETED:
12:35 PM
NARRATIVE
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On 01/24/2020 at 9:00 AM Licensing Program Analysts (LPAs) Arminder Singh and Monica Mathur met with Licensee, Iluminada Dela Cruz for an unannounced random annual inspection and explained the purpose of today's inspection. During the inspection her Assistant (Licensee's husband) who is fingerprint cleared was present. There is 1 preschool aged child (3.5 years old) present during inspection. Days and hours of operation are Mon - Fri, 7 AM to 5:30 PM.

At 9:15 AM the home was toured to conduct a health and safety inspection. During inspection LPA's observed there were medicines present on the kitchen island. Kitchen area was not made inaccessible, and the medication was easily accessible to the child. Paint cans were observed in accessible area of backyard also.

The home is a one story home with an attached garage that is converted into a room. The home consists of a kitchen, dining room, living room, two bedrooms, one bathroom, and a backyard that has two storage sheds(locked). The ON LIMIT AREAS are the dining room, living room, bedroom #1, garage, and the backyard. The remainder of home is OFF LIMITS which will be inaccessible by closed and or/locked doors and visual supervision. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, and carbon monoxide detector. There is a wall heater that is working and in good repair. Wall heater is located in the hallway that was turned on, was observed to be hot to the touch, and was NOT properly screened or barricaded. Licensee states there are no firearms in the home. The bedroom #1 is the isolation room. She has a first aid kit.

At 10:15 AM Five (5) child's records (C1-C5) were reviewed by the LPAs and the licensee. Files are complete. Both Licensee and husband have current Pediatric CPR and First Aid certificates are current and expire on June 10, 2020(licensee) and May 6, 2020(husband). Mandated reporter training is current. Licensee and Assistant do not have documentation for immunization against measles, pertussis and influenza.

Please see LIC 809 C for additional information
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: DELA CRUZ, ILUMINADA
FACILITY NUMBER: 013419077
VISIT DATE: 01/24/2020
NARRATIVE
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This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation.
REMINDERS/RESOURCES
Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

- LPAs provided Lead Poisoning Information Flyer.

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov or send email Child Care Advocate Program.

Deficiencies were cited today. See 809-D for details. Due the issuance of a Type A Citation during today's visit, a copy of this Licensing Report must be POSTED AND PROVIDED to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

A NOTICE OF SITE VISIT was issued and must remain posted for 30 days. Exit interview was conducted and appeal rights were provided.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: DELA CRUZ, ILUMINADA
FACILITY NUMBER: 013419077
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2020
Section Cited

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102417 Operation of a Family Child Care Home: (g)(4) Poisons detergents, cleaning compounds, medicines, firearms, and other items which could pose a danger if readily available to children shall be stored where they are inaccesible to children. This requirement was not met as evidenced by:
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Per LPA 's inspection medications were kept accessible to children on the kitchen island. During inspection the child was present in the area.Paint cans were observed in accessible area of backyard also. This poses an immediate risk to the health and safety of children.
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Due the issuance of a Type A Citation during today's visit, a copy of this Licensing Report must be POSTED AND PROVIDED to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: DELA CRUZ, ILUMINADA
FACILITY NUMBER: 013419077
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2020
Section Cited

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102417 Operation of a Family Child Care Home: (g)(1) Fire places and open-face heaters shall be screened to prevent access by children.[...] This requirement was not met as evidenced by:
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Per LPA's inspection wall heater was unscreened,operating and hot to the touch. This poses a potential risk to the health and safety of children.
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Type B
02/24/2020
Section Cited

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Health and Safety Code: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. [...] This requirement was not met as evidenced by:
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Per LPA's review of files, licensee and Assistant (husband) did not have documentation for immunzations available. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4