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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422861
Report Date: 07/02/2021
Date Signed: 07/02/2021 10:42:00 AM

COMPREHENSIVE INSPECTION
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:VAZQUEZ DE RODRIGUEZ, KARINAFACILITY NUMBER:
013422861
ADMINISTRATOR:VAZQUEZ, KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(702) 339-1444
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:14CENSUS: 7DATE:
07/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karina Vazquez De RodriguezTIME COMPLETED:
10:41 AM
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On 7/2/2021 at 9:00am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Karina Vazquez De Rodriguez for an unannounced annual inspection. Present during the inspection was licensee Karina Vazquez De Rodriguez, her fingerprint cleared assistant Mohini Singh and her fingerprint cleared mother in-law Maria Rodriguez (Maria Lourdes Correa in Guardian). Licensee lives with her fingerprint cleared husband Francisco Rodriguez and two (2) children age eleven (11) and seven (7). There was one (1) infant and six (6) preschool children during the inspection. The Licensee’s home was toured for a health and safety inspection. The operating hours are 6:00am – 6:00pm Monday – Friday.

ON LIMITS AREA: Living Room, Playroom, Kitchen, all 3 Bedroom’s, Bathroom and Backyard


OFF LIMITS AREA: Garage and Studio
ISOLATION AREA: Living Room

The facility is a single-story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and no pets.

The home has one (1) fully charged 3A40BC fire extinguisher located in the kitchen. One (1) working carbon monoxide detector in the kitchen, one smoke detector in the hallway and the children’s playroom. There is a fire pull down station by the front door as well. The home is equipped with many windows for proper air and ventilation. There is a wall heater located in the hallway that is gated and made inaccessible to the children in care. LPA observed no bodies of water in or around the home.

Cont on 809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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: VAZQUEZ DE RODRIGUEZ, KARINA
FACILITY NUMBER: 013422861
VISIT DATE: 07/02/2021
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At 9:45am LPA obtained the facility roster and requested the files for five (5) children. All files and the facility roster were complete. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is current with an expiration date of 1/2022. Licensee’s Mandated Reporter training is in the process of being completed. All required forms are posted and visible for public view in the hallway.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children 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 2 years by visiting www.mandatedreporterca.com.



Incidental Medical Services (IMS) policy was discussed as well. Licensee was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.
Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Cont on 809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: VAZQUEZ DE RODRIGUEZ, KARINA
FACILITY NUMBER: 013422861
VISIT DATE: 07/02/2021
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Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There are no deficiencies being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
LIC809 (FAS) - (06/04)
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