073402494-11-21-2019-02-CC-PPEN-BJ5VW9-20191121154735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402494
Report Date: 11/21/2019
Date Signed: 11/21/2019 03:47:42 PM

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:	VALENCIA, CELIA		FACILITY NUMBER:	073402494
ADMINISTRATOR:	VALENCIA, CELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 262-0308
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 10	DATE:	11/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Celia Valencia		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced annual random site inspection for this facility at 2:05. Present at the time of LPA's arrival was licensee, Celia Valencia, licensee's husband, Jesus Valencia, and nine children in care consisting of two infants and eight preschool age children. All adults present are background cleared. The facility is within ratio and capacity. LPA toured all on limits areas for a health and safety inspection. The areas on limits for children in care are all on the lower level of the home and consist of the main daycare room with adjacent bathroom, the sunroom, and the laundry room area which has a changing table for children. Per licensee, there are no firearms present or stored on the premises. Off limits areas are made inaccessible by child safety gating or closed doors and visual supervision. There is child safety gating at the base of the stairs. The home is clean and organized with available heating and ventilation for safety and comfort. Furnishings and equipment, including infant sleeping equipment, are age appropriate and in good repair. There is a working carbon monoxide detector, working smoke detector and fully charged 3A10BC fire extinguisher. The backyard/play area is fully fenced and available to children in care. There are no high climbing equipment or swings present. Outdoor toys and equipment are age appropriate and free of observed broken/sharp pieces. The facility has two pets (dogs). There are no pools, hot tubs or other accessible bodies of water. Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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: VALENCIA, CELIA	FACILITY NUMBER: 073402494
	VISIT DATE: 11/21/2019

NARRATIVE

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LPA reviewed facility, personnel and children's records including consent for emergency medical treatment forms, emergency ID forms and children's immunization records. Licensee's CPR/First Aid expires in 2020.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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

LPA reviewed with licensee the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov.

There were no deficiencies cited during this inspection. A copy of the Safe Sleep For Infants PIN including "New Proposed Safe Sleep Regulations and Best Practices" was provided and reviewed. A notice of site visit was printed and posted and is to remain posted for 30 days. Appeal rights were provided and a copy of this report is to remain in the facility records for three years from today's date

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

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