073408531-5-17-2023-02-CC-MSUN-CRWUR7-20230517154817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408531
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:50:41 PM

Document Has Been Signed on 05/17/2023 03:50 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:	FIGUEROA, EVELYNG		FACILITY NUMBER:	073408531
ADMINISTRATOR:	FIGUEROA, EVELYNG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 267-9406
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	14	CENSUS: 0	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Evelyng Figuero		TIME COMPLETED:	04:00 PM

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On 5/17/23 at 2:05 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection Evelyng Figuero Family Childcare Home. LPA met with Evelyng Figuero and explained the purpose of today's inspection. The family childcare home days and hours are Monday to Friday 6:00 AM to 6:00 PM. Present in the home at time of inspection were licensee and licensee's mother. Licensee states she is only caring for her grandchildren.

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.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A10BC fire extinguisher, smoke alarm and carbon monoxide detector in the home.

The OFF-LIMIT areas are the entire upstairs, downstairs bedroom, laundry room and garage. These areas are inaccessible to children in care by closed safety gates and visual supervision. IN-USE living room, family room, downstairs bathroom, kitchen and backyard is used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children. LPA reminded licensee that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are one dog, no arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: FIGUEROA, EVELYNG	FACILITY NUMBER: 073408531
	VISIT DATE: 05/17/2023

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Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there above ground pools behind a fence.
Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 3/24, pediatric CPR and first aid expires 3/24.
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
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.
The following deficiency were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Evelyng Figuero.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/17/2023 03:50 PM - It Cannot Be Edited

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: FIGUEROA, EVELYNG	FACILITY NUMBER: 073408531
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(5)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above due to not having a pool cover or 5 foot fence surrounding above ground pool which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2023
	Plan of Correction
1 2 3 4	Licensee shall get a pool cover, 5 foot fence or remove the pool

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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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