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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401628
Report Date: 11/07/2022
Date Signed: 11/07/2022 03:24:36 PM


Document Has Been Signed on 11/07/2022 03:24 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:PAEZ, BLISSFACILITY NUMBER:
073401628
ADMINISTRATOR:PAEZ, BLISSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 757-9783
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 1DATE:
11/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Bliss PaezTIME COMPLETED:
04:15 PM
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On 11/07/2022 at 1:10 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Bliss Paez's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there was 1 child in care(1 infant) and 1 child enrolled. Licensee, Licensee's spouse, licensee's two adult children and 1 minor child were in the facility during inspection. Licensee adult child is currently living out of state and is just visiting. Family members residing in the home are licensee, licensee spouse, licensee adult child and licensee's 4 minor children ages 11, 10, 9 and 6. Licensee and all adults in the home have criminal background clearance. Facility hours of operations are Monday - Friday from 6:00 AM - 6:00 PM.

This is a two story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, 2 sun rooms, laundry room, attached garage, and a backyard.
The children on limits areas: Living room, family room, kitchen, dining room, sun room 1(play area) and backyard.
Areas off limits include: Master bedroom on first floor, Entire second floor which includes 3 bedrooms, 2 bathrooms, attached garage, laundry room, sun room 2.
The LPA toured all areas used by children during this visit.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 3A40BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a screened fireplace in the family room. Licensee last conducted fire drill 08/26/2022. Licensee stated there are no pets in the facility.

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SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
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: PAEZ, BLISS
FACILITY NUMBER: 073401628
VISIT DATE: 11/07/2022
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*Page 2*

Licensee stated she does not use backyard for outdoor play activities. Licensee stated she uses a park nearby for outdoor activity. LPA reminded applicant when outside of facility, 100% supervision of children in care is required. No bodies of water were observed.

Facility does not provide transportation for children, but licensee understands that children cannot be left alone, unattended in parked vehicles

Child record were reviewed to ensure that each child has an Identification and Emergency form. During review of child's record, it was discovered that infant did not have a sleep log in their file. LPA explained the requirements for Safe Sleep Regulations to the licensee and informed licensee the importance of completing and maintain a sleep log for infants in care. Licensee stated she will complete and maintain sleep log for infants. The licensee Pediatric First Aid and CPR certificate will expire in 09/2024. Required postings were observed near the entrance.

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee has not completed Mandated Reporter training. Licensee stated she will complete Mandated Reporter training by 11/14/2022.



LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

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.

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SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 2 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PAEZ, BLISS
FACILITY NUMBER: 073401628
VISIT DATE: 11/07/2022
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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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee 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.

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

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Bliss Paez. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
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