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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419077
Report Date: 12/22/2022
Date Signed: 12/22/2022 02:44:34 PM


Document Has Been Signed on 12/22/2022 02:44 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
BAY AREA-CC OAKLAND, 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: 6DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Iluminada Dela CruzTIME COMPLETED:
03:15 PM
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On 12/22/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Iluminada Dela Cruz and her fingerprint cleared Husband and explained the purpose of today's visit. There are 6 children present today. Children were napping during LPA's visit. LPA reviewed record of three (3) children today (C1-C3). Child's file included Licensing documents per regulation and immunization records. The home was toured to conduct a health and safety inspection. The Licensee's hours of operation are Monday-Friday, 7:30AM-5:30PM. Licensee has a working telephone in the home.

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).

ON LIMIT AREAS are the dining room, living room, bedroom #1, garage, and the backyard.

OFF LIMITS- remainder of home 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.

ISOLATION AREA will be the dining room.


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SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: DELA CRUZ, ILUMINADA
FACILITY NUMBER: 013419077
VISIT DATE: 12/22/2022
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The home is sanitary, safe and orderly, with central heating and ventilation for safety and comfort. LPA observed required Postings on the wall. There is a wall heater located in the hallway that is properly barricaded and made inaccessible to children. LPA observed: fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and out of reach of children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Licensee does not have any firearms at facility. Licensee does not have any pets.

Licensee has current CPR and First Aid Certification which expires 03/2024.


LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years. Licensee was reminded that fire/disaster drills are to be conducted every six months.

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
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: DELA CRUZ, ILUMINADA
FACILITY NUMBER: 013419077
VISIT DATE: 12/22/2022
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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/inspection-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 web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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.

There were no deficiencies in today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee, Iluminada Dela Cruz.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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