073408651-5-27-2020-02-CC-LCHW-BPZTJA-20200527144601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408651
Report Date: 05/27/2020
Date Signed: 05/27/2020 02:46:21 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:	MATTOS, ANGEL M		FACILITY NUMBER:	073408651
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	05/27/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	MATTOS, ANGEL M		TIME COMPLETED:	10:58 AM

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) LaKeisha Chew conducted an announced Family Child Care Case Management inspection and Increase in Capacity. Due to the COVID-19 and the inability to conduct an on-site inspection the tele-inspection meeting was conducted via Zoom. LPA met with licensee Mattos, Angel. LPA explained the purpose of the inspection. Licensee guided LPA on a tour of home inside and out for health and safety inspection. The facility is a single story 3-bedroom 2-bathroom home with attached 2-car garage. The home consists of a master bedroom with master bathroom, one (1) bathroom in hallway, two (2) bedrooms, living room, dining room, kitchen, garage and fully fenced backyard. The on-limits area consists of living room, dining room, hallway bathroom, kitchen and two (2) bedrooms. The off-limit areas consist of Master bedroom and master bathroom, garage, and left and right side of the backyard which will be inaccessible by closed and/or locked gates and visual supervision. The fireplace is securely screened and inaccessible to children in care. The isolation area will be the two (2) bedrooms. The outdoor play area is free from defects or dangerous conditions. Outdoor play area has a trampoline and chicken coop which is inaccessible to children in care by closed and locked gates and visual supervision. Present during inspection was licensee, fingerprint cleared assistant Crystal McDermott, licensee school age child (13 years old) and three (3) children in care one (1) infant (10 months) and two (2) preschoolers (2 years and 5 years old). Licensee stated two adults (Licensee & her husband) and her school-age child reside in the home. LPA observed the licensee is operating within the license capacity, during inspection. LPA did not observe no bodies of water on the premises, during inspection. All hazardous materials and toxins were kept in an off-limits area of home and was inaccessible to children in care during inspection.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

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: MATTOS, ANGEL M	FACILITY NUMBER: 073408651
	VISIT DATE: 05/27/2020

NARRATIVE

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Mandatory forms were posted in a prominent, publicly accessible area in the family childcare home. Licensee has a current roster of the children in care available for review and copy was obtained.
Per licensee, her facility operation hours are from 6:30AM – 05:30PM, Monday thru Friday. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone.

The licensee Angel Mattos and her assistant Crystal McDermott are both following the new immunization law which pertains to day care providers. The licensee Preventative Health and Safety training was completed 02/25/2018. Licensee Pediatric CPR and First Aid certificate is current, expiring 10/26/2021. Licensee AB-1207 Mandated Reporter Certificate is current, expiring 02/07/2021.
Assistant Crystal McDermott Pediatric CPR and First Aid certificate is current, expiring 12/14/2021. Assistant Crystal McDermott AB-1207 Mandated Reporter Certificate is current, expiring 12/12/2021.

Per licensee, there are no firearms in the home. The facility has 12 pets: two (2) dogs, one (1) cat and nine (9) chickens. Control of property was provided by Deed of Trust, Trustor Ronnie Mattos and Angel Mattos, husband and wife. On March 10, 2020 a Fire Safety Inspection was conducted by ECC Fire Protection Department special conditions as described on STD 850 garage is off-limits to children in care.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. The licensee was also encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There are no deficiencies cited during today’s inspection. This home is recommended for an increase of capacity.
Exit interview was conducted with Licensee. A copy of the appeal rights, Notice of Site visit will be mailed. The Notice of Site visit must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

LIC809 (FAS) - (06/04)

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