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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407245
Report Date: 09/17/2019
Date Signed: 09/17/2019 01:09:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:DIAZ, ROSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407245
ADMINISTRATOR:DIAZ, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 988-9212
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 4DATE:
09/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosa DiazTIME COMPLETED:
01:20 PM
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On 09/17/19 an Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), David Wilson. Prior to this inspection a review of staff records on 09/17/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection the home and grounds were toured. The licensee was supervising two children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours will normally be provided 5:00am - 7pm, Monday thru Friday. The floor plan submitted by the licensee was reviewed and verified. Off limits areas were inaccessible to children in care: The garage is inaccessible via high latch, door knob key lock and child proof door knob lock. The 3-bedrooms were inaccessible via child proof door knob lock and door knob key lock. The home appeared to be clean and orderly at this time and will remain so during child care hours. There was a working telephone in the home. The sharp knives, cleaning supplies, and medicines were stored out of the reach of children. The applicant reported there are no weapons in the home and none were observed during the visit. The children in care will have access to age appropriate toys and equipment. The home was equipped with a working smoke detector, carbon monoxide detector, and charged fire extinguisher rated at least 2A:10B:C. The fireplace is not operating; it was securely screened and sealed. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There was a small sized play structure trampoline on the premises and licensee stated understanding to follow manufacturers instructions and never to allow more than one age and weight appropriate child to play at any one time. There was no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency. The licensee has current pediatric CPR and First Aid certification, which expire on 11/20/2020. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Licensee stated poisons are locked in garage, and none were observed to be accessible.
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SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: DIAZ, ROSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407245
VISIT DATE: 09/17/2019
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The licensee stated there are no firearms; none were observed during today's inspection. Four children's records were reviewed; required emergency information was observed to be on file.

The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417 (See Evaluator Manual Regulation Interpretations and Procedures). 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 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, www.ada.gov/childqanda.htm. This report, as well as the American Academy of Pediatrics Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee.
All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019
LIC809 (FAS) - (06/04)
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