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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406180
Report Date: 05/17/2019
Date Signed: 05/17/2019 05:35:37 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:NAVARRO, ROSAFACILITY NUMBER:
073406180
ADMINISTRATOR:NAVARRO, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 759-7244
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:14CENSUS: 10DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:ROSA NAVARROTIME COMPLETED:
05:45 PM
NARRATIVE
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LPA Tasha Alexander met with licensee Rosa Navarro for an unannounced ANNUAL/RANDOM inspection. Present for the inspection were licensee, assistant Maria Rodriguez, licensee's daughter and 10 children in care, consisting of 1 infant, 3 preschoolers, and 6 school-age. Today upon arrival, licensee had a friend visiting who had 4 children with her which made the capacity 14. This individual(and the children) left approximately 10 minutes after my arrival. LPA toured the facility and backyard for a health and safety inspection. The children's files contained emergency information and immunization blue cards. The home is equipped with a 3A40BC fire extinguisher and working smoke detector. Today, Licensee says the carbon monoxide detector is located inside of her adult daughter's locked bedroom and could not be tested. There is a working telephone 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 2/2/21 respectively. The off limits areas are all bedrooms, laundry room 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 5/17/19 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. Today, both licensee and assistant do not have immunization records in file.

CONTINUED ON 809- C
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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 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: NAVARRO, ROSA
FACILITY NUMBER: 073406180
VISIT DATE: 05/17/2019
NARRATIVE
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The newly implemented mandatory mandated reporter training course was discussed. Today staff does not have certificates of completion on file. There are 3 children enrolled and there are 3 cribs available for napping. The Safe sleep concepts were given and explained today.

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

The attached type B deficiencies are cited today and must be corrected by the due date. An exit interview was conducted. This report must be available for public review for 3 years. A notice of site visit was posted.



SEE 809-D FOR CITATION
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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: NAVARRO, ROSA
FACILITY NUMBER: 073406180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2019
Section Cited
HSC
1597.622
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597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions

(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
REQUIREMENT WAS NOT MET: TODAY STAFF DOES NOT HAVE IMMUNIZATION RECORDS IN FILE
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STAFF WILL OBTAIN IMMUNIZATION RECORDS AND SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 6/7/19. DOCUMENTATION MUST SHOW VACCINATIONS FOR PERTUSSIS (DTAP), MEASLES(MMR) AND INFLUENZA (FLU). IF RECORDS ARE UNABLE TO BE OBTAINED A TITRE BLOOD TEST MUST BE ADMINISTERED TO DETERMINE IF THE VACCINATIONS WERE RECEIVED.
Type B
06/07/2019
Section Cited
HSC
1596.8662(b)(1)
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1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
REQUIREMENT WAS NOT MET: STAFF DOES NOT HAVE CERTIFICATES OF COMPLETION IN FILES
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STAFF WILL COMPLETE THE MADATED REPORTER TRAINING COURSE AND SUBMIT THE CERTIFICATES OF COMPLETION TO COMMUNITY CARE LICENSING BY 6/7/19.
Type B
05/31/2019
Section Cited
CCR
102417(g)(9)a1
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102417 Operation of a Family Child Care Home
(9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.
(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.
1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
REQUIREMENT WAS NOT MET: TODAY LICENSEE IS UNABLE TO LOCATE HER CURRENT FIRE/DISASTER DRILL LOG
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LICENSEE WILL CONDUCT A FIRE/DISASTER DRILL WITH CHILDREN IN CARE, DOCUMENT AND SUBMIT A COPY OF THE UPDATED LOG TO COMMUNITY CARE LICENSING BY 5/31/19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3