115407759-7-14-2020-13-CC-CWIT-BRHSU3-20200714141027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 115407759
Report Date: 07/09/2020
Date Signed: 07/14/2020 02:10:36 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:	DOMINGUEZ-GARCIA, CONSUELO FAMILY CHILD CARE HOME		FACILITY NUMBER:	115407759
ADMINISTRATOR:	DOMINGUEZ-GARCIA, CONSUELO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 519-6211
CITY:	ORLAND	STATE: CA	ZIP CODE:	95963
CAPACITY:	14	CENSUS:	DATE:	07/09/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Consuelo "Connie" Dominguez-Garcia		TIME COMPLETED:	11:00 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	The facility pre-licensing inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst, Wisehart. The applicant is requesting a license for a capacity of 14. Services will be available 7:30 am - 5:30 pm, Monday thru Friday. The residence is a 3 bedroom, 2 bath home. There is two adults living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Children will have access to the living room, two bedrooms, the kitchen/dining area, laundry room and right bathroom and left bathroom ( front portion). The homes off limits areas include, one bedroom and left bathroom (back portion) which will be made inaccessible via door knob covers and/or gates. The poisons/chemicals are stored in a locked backyard shed which LPA confirmed during the tour. The applicant understands that poisons shall be kept locked . The home appears clean and orderly at this time and will remain so during childcare hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The applicant stated no firearms or ammunition is stored on site and none were observed. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector. The carbon monoxide detector has to be installed and the fire extinguisher was not rated at 2A10BC and will be replaced.. The applicant stated children will use the backyard as an outdoor play area and it is fully fenced. To access the play yard children have to utilize stairs which will need to be gated (top/bottom) and additional rail slats will be to be added to back door stair exit if utilized. If master bedroom door is used to access back yard then stairs or a ramp would need to be installed. There were no permanent bodies of water on the property and none were observed. The licensee has a wood burning fire place which is not in use, however, licensee understands if ever utilized a secured fire fence would need to be installed prior to use. The applicant currently is not providing Incidental Medical Services (IMS) but would consider accepting a child with medical needs and the Licensee understands the need to file an IMS plan with CCL if accepting a child with those needs. 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.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020

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: DOMINGUEZ-GARCIA, CONSUELO FAMILY CHILD CARE HOME	FACILITY NUMBER: 115407759
	VISIT DATE: 07/09/2020

NARRATIVE

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Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional childcare liability insurance. Control of Property is on file. Parent's rights poster will be posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid (3/19/21) as well as Mandated Reporter Training (expires 1/29/22). The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in those areas where childcare is provided. The Licensee understands that the use of baby walkers, bouncers or similar items are not approved equipment for use in licensed childcare homes. The licensee has a netted trampoline on the premises however, the licensee indicated it would be removed from the premises.

The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family childcare home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/. Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advanced notice. This report was reviewed and discussed with the applicant. Guide to Safe Sleeping Practices pamphlet was discussed along with the Provider Notice and Flyer for Lead Exposure Testing.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020

LIC809 (FAS) - (06/04)

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