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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407245
Report Date: 03/05/2020
Date Signed: 03/05/2020 04:01:36 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: 0DATE:
03/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rosa DiazTIME COMPLETED:
04:10 PM
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On 03/05/2020 Licensing Program Analyst (LPA), David Wilson arrived to conduct a monitoring inspection per the informal office visit held on 08/08/2019 (see LIC809 08/08/2019). Prior to this inspection on 03/04/2019 a review of staff records 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. On this date of inspection there were no children in care. 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 when 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: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: DIAZ, ROSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407245
VISIT DATE: 03/05/2020
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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: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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