073405987-8-14-2019-02-CC-THAR-BF2TUQ-20190814150242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405987
Report Date: 08/14/2019
Date Signed: 08/14/2019 03:02:48 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:	TERRIQUEZ, MARIA		FACILITY NUMBER:	073405987
ADMINISTRATOR:	TERRIQUEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 207-3844
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	14	CENSUS: 5	DATE:	08/14/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	MARIA TERRIQUEZ		TIME COMPLETED:	03:00 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	LPA Tasha Alexander met with licensee Maria Terriquez for an unannounced ANNUAL/REQUIRED inspection. Present for the inspection were licensee, her son Daniel and 5 children in care, consisting of 2 infants, 2 preschoolers, and 1 school-age. LPA toured the facility and backyard for a health and safety inspection. The children's files contained emergency information. The home is equipped with a 2A10BC fire extinguisher, working smoke detector, and working carbon monoxide detector. There is a working telephone(no change) in the home. Per licensee there are no fire arms on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 9/9/19. The off limits areas are entire upstairs and garage. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates. A review of staff records on 8/14/19 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles, and influenza or has an exemption. Licensee has immunization records in file today. Flu vaccination is up to date. Licensee has decided to decline the flu vaccination in the future due to becoming ill after receiving last year's vaccination. LPA instructed licensee to complete a decline letter for her file The newly implemented mandatory mandated reporter training course was discussed today. Licensee has a certificate of completion dated 3/9/18. Reminder: renew 3/2020 The new Safe Sleep Practices for infants was also discussed today. There are 2 infants present today. one of which is licensee's own grandchild/resident. There is are 2 play pens available for napping. Safe sleep practices for has been given and explained.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TERRIQUEZ, MARIA	FACILITY NUMBER: 073405987
	VISIT DATE: 08/14/2019

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
26
27
28
29
30
31
32

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

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2