073409171-6-15-2021-02-CC-LDYN-C3ZQ2G-20210615114708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409171
Report Date: 06/15/2021
Date Signed: 06/15/2021 11:47:13 AM

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:	ESCOBAR, MARIA & ESCOBAR, MIGUEL		FACILITY NUMBER:	073409171
ADMINISTRATOR:	ESCOBAR, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 695-4806
CITY:	CONCORD	STATE: CA	ZIP CODE:	94520
CAPACITY:	14	CENSUS: 0	DATE:	06/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Maria & Miguel Escobar		TIME COMPLETED:	12:00 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	On 6/15/21 at 9:45am, Licensing Program Manager (LPM) Loretta Dyson arrived at the home for an announced prelicensing inspection. An application for a location change was received. LPM met with both applicants. There were no children present at the time of inspection. LPM toured the home with the licensee to conduct a health and safety inspection. The home is a single story home which is neat and clean with heating and ventilation for safety and comfort. The home consists of the living room, dining area, kitchen, 3 bedrooms, 2 bathrooms and the garage. The OFF LIMIT AREA will be the garage, which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, dining area, kitchen, 3 bedrooms, and 2 bathrooms. The ISOLATION AREA will be the covered patio or one of the bedrooms. The outdoor play area will be the fenced backyard, which is free from defects or dangerous conditions. There is an ample supply of age appropriate furniture, equipment, toys and activities that are safe and appear to be in good repair. LPM did not observe any bodies of water, hazardous items, toxins or medications accessible to children today. The home has a fully charged 2A10BC fire extinguisher, working combination smoke/carbon monoxide detector, telephone, and first aid supplies. Both of the applicants have current CPR and First Aid certificates which will expire on 5/8/23. The fireplace in the living room is blocked to prevent access by children. Per applicant, there are no firearms in the home. An electronic copy of the mortgage statement was reviewed and shows control of property. The applicants have children's files and files for assistants, and verified that they include all required documents. LPM reviewed the ratio and capacity for a large family child care home, and reminded the licensee that an assistant, who is at least 14 years of age, must be present in the home and helping to care for children. LPM advised the licensee that if assistant is not present, the ratio and capacity requirements for a small family child care home must be followed.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: ESCOBAR, MARIA & ESCOBAR, MIGUEL	FACILITY NUMBER: 073409171
	VISIT DATE: 06/15/2021

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Incidental Medical Services (IMS) policy was discussed. 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 applicant was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter. The applicants have provided proof that the required mandated reporter training was completed on 1/16/20 and 1/17/20, respectively.

The applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. LPM discussed safe sleep practices and policy.

This home will be licensed once the following is complete:
- fire clearance report (850) from the Contra Costa County Fire Prevention
- proof of enrollment an approved Preventative Health & Safety training that includes 1 hour nutrition and lead poisoning prevention training

LPM reminded the applicant that compliance with all Title 22 regulations and applicable Health and Safety regulations, must be maintained at all times. This report shall remain on file for 3 years. An exit interview conducted.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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