073407719-11-21-2019-02-CC-PPEN-BJ5TCW-20191121133725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407719
Report Date: 11/21/2019
Date Signed: 11/21/2019 01:38:11 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:	GARCIA, VERONICA		FACILITY NUMBER:	073407719
ADMINISTRATOR:	GARCIA, VERONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 710-1461
CITY:	EL SOBRANTE	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 9	DATE:	11/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Veronica Garcia		TIME COMPLETED:	01:40 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 random annual site inspection for this facility at 11:45. LPA met with licensee, Veronica Garcia, and toured all areas of the residence on limits to children in care for a health and safety inspection. Also present during this inspection were nine children in care, consisting of four infants and five preschool age children, and licensee's assistant, Chelsey Martinez. All adults present are background cleared. The facility is within ratio and capacity. The areas on-limits to children in care are the converted garage/playroom, and the living room, dining room area and hall bathroom in the main residence. Per licensee, there are no firearms present or stored on the premises. The facility has heating and ventilation for safety and comfort including portable heating in the playroom. There were no hazardous items/toxins observed to be accessible to children in care. Furnishings and equipment, including infant sleeping equipment, are age appropriate and in good repair. LPA provided licensee with a copy of the Spanish language Infant Safe Sleep PIN and discussed safe sleep best practices for infants. The facility has a functioning carbon monoxide detector, working smoked detector and fully charged fire extinguisher. Smoke detectors and carbon monoxide detector are present in the main residence and the separate playroom. The fireplace is screened to prevent access by children. The outdoor patio/play area located between the living room and the playroom is fully enclosed and available to children in care. There are no hazardous conditions observed in the patio area. There are no high climbing pieces of equipment or swings present. There are no pools, hot tubs or other bodies of water accessible to children. 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)

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: GARCIA, VERONICA	FACILITY NUMBER: 073407719
	VISIT DATE: 11/21/2019

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

Page 2*****************************************************************************************************

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. LPA reviewed facility, personnel and children's records including parent's rights forms, emergency ID forms and children's immunization records. Licensee has current CPR/First Aid certification which expires in 2021.

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

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 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)

Page: 2 of 2