073400154-9-20-2022-02-CC-CFES-CJFU8K-20220920152139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073400154
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:21:47 PM

Document Has Been Signed on 09/20/2022 03:21 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:	ESCOBAR, THELMA		FACILITY NUMBER:	073400154
ADMINISTRATOR:	ESCOBAR, THELMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 639-5397
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	12	CENSUS: 7	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Thelma Escobar		TIME COMPLETED:	03:30 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 9/20/2022 at 1:10pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Thelma Escobar for an Unannounced Required Annual Inspection. Present during the inspection were three infants and four preschoolers in care and an additional three finger print cleared adults. Residing in the home is the Licensee, her fingerprint cleared husband and two adult sons. Licensee’s home was toured for a health and safety inspection. The facility operates 7:30am – 5:00pm, Monday - Friday. The home is a two story house that consists of seven bedrooms and three bathrooms. The entrance to the day care is the front door. The inside and outside of the home were inspected, LPA observed the on limit areas to be neat, clean with age appropriate materials and toys for the children. All toxins, medications, and hazardous materials were observed to be in inaccessible areas. There is an empty pool on the property that is covered and has a self locking gate to protect the children in care. Licensee confirmed there are no firearms and there is a dog and bird in the home. ON LIMITS AREA: are the living Room as a walk through space to the family room (2 rooms) which is the main day area, the spare room that is connected to the family room, the bathroom within that room, the bathroom in the family and a portion of the enclosed backyard. OFF LIMITS AREA: are the entire upstairs, the kitchen area, the garage, the laundry room next to the family room, the, bedroom in the spare room (lower floor), the entire right side of the backyard when facing the home, the two sheds in the backyard and the gated pool area which is also on the right side of the yard, which will be inaccessible by closed and/or locked doors or visual supervision. ISOLATION AREA: Spare Room The home has a fully charged 3A40BC fire extinguisher located in the family room, a working smoke detector and carbon monoxide detector in the main area of the day care, and a working telephone. There is a pull down fire alarm near the exit in the family room. All required forms are now posted and visible for public view. The home conducts and documents fire and disaster drills twice a year with the last one conducted on 8/26/2022. REPORT CONTINUES ON 809C

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ESCOBAR, THELMA	FACILITY NUMBER: 073400154
	VISIT DATE: 09/20/2022

NARRATIVE

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The home has CPR and First Aid certificates that are current and expires on 5/2024. The home was reminded of the responsibility as a mandated reporter and has provided proof of the required training completed on 6/15/21. LPA reviewed five children’s files, all persons residing in the home and obtained a copy of the facility roster.

Licensee was reminded that California Law requires Licensee 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 staff that all forms can be downloaded at www.ccld.ca.gov. Staff was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. Staff was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Staff is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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.

No IMS is being provided at this time.

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.

REPORT CONTINUES ON 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ESCOBAR, THELMA	FACILITY NUMBER: 073400154
	VISIT DATE: 09/20/2022

NARRATIVE

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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/process.

LPA discussed the safe sleep regulations with staff 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 staff 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.
For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

No citations were cited during todays inspection

Please provide the following copies to CCL for facility file:
-LIC 610A Emergency disaster form
- Updated Facility
- Proof of control of property

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted
Report and Appeal Rights provided

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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