093622098-2-3-2020-03-CC-MPAL-BLFQK5-20200203111346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093622098
Report Date: 02/03/2020
Date Signed: 02/03/2020 11:13:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	BAUTISTA, PERLA		FACILITY NUMBER:	093622098
ADMINISTRATOR:	BAUTISTA, PERLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 721-7896
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96151
CAPACITY:	14	CENSUS: 2	DATE:	02/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Perla Bautista		TIME COMPLETED:	11:30 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) Michelle Pascual met with licensee, Perla Bautista for an unannounced annual random inspection. Upon arrival today's census was two (2) children present. All adults living in the home have obtained a criminal record clearance and is on file with Licensing Office. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas are: All bedrooms, right side of deck and storage shed. Home has a working phone, functioning smoke and carbon monoxide detector and a 2A10BC fire extinguisher that meet standards established by the State Fire Marshall. Toxic and hazardous items; such as cleaning compounds are inaccessible to children. Licensee understands that 100% supervision is required in unfenced areas while children are present. There are no bodies of water on the premises. Children’s files were reviewed and contained current immunization and emergency contact ID information. A current roster is being maintained and fire and disaster drills are conducted at least once every six month and are properly log. Current pediatric CPR and first aid certification was verified and expires on 06/2020. LPA also discussed the Smoking Probation Regulation (AB 1819-Smoking Prohibition), the Nutritious Beverage Act and the Incidental Medical Services (IMS) policies with the licensee. Licensee was updated on immunization requirements from the Department of Public Health(CDHP) that will become effective July 1, 2019. Additional information and resources can be found on the https://www.shotsforschool.org website.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BAUTISTA, PERLA	FACILITY NUMBER: 093622098
	VISIT DATE: 02/03/2020

NARRATIVE

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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.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

LIC809 (FAS) - (06/04)

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