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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407719
Report Date: 05/23/2022
Date Signed: 05/23/2022 02:14:28 PM


Document Has Been Signed on 05/23/2022 02:14 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:GARCIA, VERONICAFACILITY NUMBER:
073407719
ADMINISTRATOR:GARCIA, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 710-1461
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 13DATE:
05/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Veroncia GarciaTIME COMPLETED:
02:15 PM
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On 05/23/2022 at 12:45 PM Licensing Program Analyst Nyeesha Blount and Melissa Domantay conducted an unannounced Random Annual Required 1 year inspection. LPA meet with Licensee Veroncia Garcia
LPA explained the purpose of today's inspection.Hours of operation is from Monday through Friday 8:00 AM to 5:00 PM. Present in the home today was Assistant Veronica Medelesromero who is background cleared,
13 Preschool age children were present. licensee is in compliance for the maximum licensed capacity and ration for a large Family child care home.

ISOLATION AREA~ will be in the Play room of the home.

OFF LIMIT AREA ~ All bedrooms, closets, garage and 1 bathroom located in the back of the home.

ON LIMIT AREA ~ family room, Kitchen, dinning room, play room and Bathroom in the hallway.

OUTDOOR SPACE~ LPA toured the backyard area and observed it was fenced all play structures were properly secured. there are no body's of water in the play yard, 2 pet dogs.

There are no hazardous items/toxins observed to be accessible to children. Furnishings and equipment, including infant sleeping equipment, are age appropriate and free of observed sharp/broken pieces. there is appropriate school age toys and furniture. Licensee stated there are no firearms stored or present on the premises.

There is a working smoke detector, working carbon monoxide detector and fully charged 2A10BC fire extinguisher.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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: GARCIA, VERONICA
FACILITY NUMBER: 073407719
VISIT DATE: 05/23/2022
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LPA'S reviewed the facility, staff and children's records including parents' rights forms, emergency ID forms and consent for emergency medical treatment forms. Licensee CPR/First Aid, Mandated Reporter Certificate for Licensee is all up to date.

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. there are no firearms stored or present in the home.


Per 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

Licensee was reminded that all adults 18 and over living or working in the home, 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.


Licensee was reminded about importance to stay in compliance with mandated reporter training and maintenance of sleep logs for all infants in care. In the areas that were evaluated, no regulatory violations were observed.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the licensee Veroncia Garcia..
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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