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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422271
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:45:19 PM


Document Has Been Signed on 05/04/2022 03:45 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:LEON, IRMAFACILITY NUMBER:
013422271
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Irma LeonTIME COMPLETED:
04:00 PM
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On 05/04/2022 at 12:30pm, Licensing Program Analyst (LPA) Diana Campos arrived at the home for an unannounced annual required inspection. Present for this inspection were 8 children in care consisting of 2 infants, 4 preschoolers and 2 school age children. Also present during inspection was Licensee's adult daughter who assists with the day care. The areas of the home used for the child care were toured to conduct a health and safety inspection.

The two story home consists of the living room, dining room, kitchen, three bedrooms, and one bathroom on the first floor and the laundry room, basement/storage room on the bottom floor and back yard.
On limit areas include the living room, dining room, kitchen, all three bedrooms and the bathroom.
Off limit areas include the garage, the basement/laundry room, the small storage room, and the rear fenced off portion of the back yard which are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be the bedroom adjacent to kitchen. The home has sufficient heat and ventilation for the safety and comfort of children in care. The fully fenced backyard is used for outdoor play, and it is free from hazards during today's inspection. There are ample age appropriate toys which appear to be in good condition. LPA did not observe any hazardous items, toxins, bodies of water or free standing water accessible to children in care during today's inspection. The heater screens are blocked to prevent access by children. The home has a fully charged fire extinguisher, smoke detector, carbon monoxide detector, working telephone, and first aid supplies. Per licensee, there are no firearms in the home. LPA reviewed children and staff files. The licensee is in ratio today. Licensee's CPR/First Aid certificate are current and will expire on 3/2023. The licensee provided proof that she completed mandated reporter training 04/2021.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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: LEON, IRMA
FACILITY NUMBER: 013422271
VISIT DATE: 05/04/2022
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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.

No deficiencies cited during today's inspection.

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

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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