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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700346
Report Date: 05/02/2022
Date Signed: 05/02/2022 12:02:27 PM


Document Has Been Signed on 05/02/2022 12:02 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:FALCON, YSAMELFACILITY NUMBER:
015700346
ADMINISTRATOR:FALCON, YSAMELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-4829
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:14CENSUS: 0DATE:
05/02/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Applicant Ysamel FalconTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Saini met Applicant Ysamel Falcon for a prelicensing visit today at this home. The purpose of this inspection was explained. This is a change of location from a previously licensed family childcare home. The facility was previously licensed at 33828 Juliet Cir, Fremont CA, 94555. Applicant stated that she is the only one who lives in this house. Applicant is applying for a Large family child care license with hours of operation: Monday through Friday 7:00 A.M. to 6:00 P.M. Capacity requirements were discussed today. Criminal record clearances are on file and will be transferred to this location. The entire house was inspected for health and safety hazards. The Day care areas are downstairs consisted of Dining room next to the kitchen, Office room, and master bedroom, attached bathroom #1, backyard. The off limit areas: the entire second level, all stairways, all closets, living room, kitchen and bathroom #2, garage, storage shed in the backyard. Per Licensee, day care children will be entering/exiting through the backyard door to get into the day care room. Applicant understands that all off limits areas of the home shall be kept inaccessible to children via barricade, locked doors, and/or visual supervision. The home has smoke detectors, a working cell phone, and first aid/emergency kit supplies. Per applicant, there are no firearms or weapons in the home. All sharp objects, cleaning supplies and other toxic items are stored out of reach of the children.There are no pools, ponds, hot tubs, or any other bodies of water on the facility premises at this time. Applicant has required Preventive Health and Safety Training certificate, including lead poisoning prevention update. The Facility will be providing snacks and meal. Applicant's First Aid/CPR certificate expires in 02/2024. Mandated Reporter training certificates for Applicant are current, and expire on 12/11/2023. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Smoking is prohibited in family childcare homes. The Applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

see next page..
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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 2


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: FALCON, YSAMEL
FACILITY NUMBER: 015700346
VISIT DATE: 05/02/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 Applicant 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 Applicant 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. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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


Large Family Child Care License is recommended effective 05/02/2022


Exit interview conducted and report was reviewed with the Applicant, Ysamel Falcon
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022
LIC809 (FAS) - (06/04)
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