013421840-1-4-2023-52-CC-SKAR-CMRRTL-20230104121833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421840
Report Date: 01/04/2023
Date Signed: 01/04/2023 12:18:50 PM

Document Has Been Signed on 01/04/2023 12:18 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:	VIVAS, HEIDI & NORKA		FACILITY NUMBER:	013421840
ADMINISTRATOR:	VIVAS, HEIDI & NORKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 961-7469
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94551
CAPACITY:	14	CENSUS: 7	DATE:	01/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Heidi Vivas		TIME COMPLETED:	12:30 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 January 4, 2023, Licensing Program Analyst (LPA) Simerjit Kaur arrived at the facility to conduct UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION. LPA met with licensee Norka Vivas. Upon initial arrival there were 6 children, which consisted of 3 preschool age children, 3 infant age children. Present during the inspection, 1 infant age child and fingerprint cleared and associated assistant Norma Bautista arrived. Also residing in the home finger print cleared and associated licensee Norka's husband Marcos Castro. Hours of operation for child care are Monday through Friday, 8:00am to 5:00pm. The facility is a one story house. The following was observed during today’s inspection: CAPACITY: The facility operates as a Family Child Care Home (large), which may have a maximum capacity of twelve (12) to fourteen (14) children. At time of inspection, there were seven children (four infants and three preschoolers).The facility is in compliance with ratio and capacity limitations. ON LIMIT AREAS (accessible to children in care): Kitchen, dining room, living room, play room located behind the kitchen, one bedroom on right of hallway for napping, hallway bathroom, and backyard, LPA observed the facility to be clean and in good repair, with heating and ventilation for safety and comfort. There are ample age appropriate toys that are observed to be safe and in good condition. The backyard has a fence surrounding the perimeter of the yard. LPA did not observe any dangerous conditions, nor any hazardous or toxic items accessible to children in the ON Limit areas of the facility today. A fire place is located in the living room and it is screened. OFF LIMIT AREAS (not accessible to children in care): Master bedroom/bathroom, garage, both sides yard. OFF Limit areas are inaccessible by closed and/or locked doors and visual supervision. Continued on LIC 809C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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: VIVAS, HEIDI & NORKA	FACILITY NUMBER: 013421840
	VISIT DATE: 01/04/2023

NARRATIVE

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Licensee is advised to contact Licensing Department so that an inspection can be completed prior to changing an OFF Limit area to ON Limit. LPA advised anytime licensees decide to move out of the licensed facility, licensees must take her name out of the license. There is trampoline in the backyard. There are no pools or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.
EMERGENCY PREPAREDNESS/SAFETY: Facility has a fully charged 3A40BC fire extinguisher. Smoke and carbon monoxide detectors were tested and found to be functioning. First aid supplies are available. A fire/disaster drill was last conducted on 10/12/2022 and meets the six month requirement. Heidi Vivas's completed Mandated Reporter Training on 1/3/2022 and Norka Vivas completed on 12/21/2021. Facility has working telephone service. Per licensee, there are no firearms in the home. LPA reviewed Emergency Disaster Plan which licensee confirmed to still be current.
STAFF/CHILDREN RECORDS REVIEW: Licensee and all adults living and/or working in the home have proper criminal background clearances. Licensees' has current CPR/First Aid training, which expires on 9/30/23. Children's files were reviewed. Licensee maintains an infant sleep log for infants up to 24 months. A facility roster is maintained.

LICENSING POSTING (required): Facility license, Earthquake Preparedness, Emergency Disaster Plan.
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

Continued on LIC 809C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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: VIVAS, HEIDI & NORKA	FACILITY NUMBER: 013421840
	VISIT DATE: 01/04/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and discussed information. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

LPA discussed facility file information and 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. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.
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 atwww.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Norka Vivas.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC809 (FAS) - (06/04)

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