136609662-10-18-2019-20-CC-YBAZ-BH42MJ-20191018173113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136609662
Report Date: 10/18/2019
Date Signed: 10/18/2019 05:31:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	LIZARRAGA, ELSA FAMILY CHILD CARE		FACILITY NUMBER:	136609662
ADMINISTRATOR:	ELSA LIZARRAGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 425-7883
CITY:	CALEXICO	STATE: CA	ZIP CODE:	92231
CAPACITY:	14	CENSUS: 3	DATE:	10/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Elsa Lizarraga		TIME COMPLETED:	05:45 PM

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Licensing Program Analysts (LPAs) Yolanda Baez and Michelle Palacio, made an unannounced visit for the purpose of a annual inspection. LPA met with Licensee's daughter Elsa Campos. Licensee arrived within 40 minutes. During this visit there were 3 children in care (3 school age children, including Licensee's school age grandchild).

LPA toured the home, this is a two story, 4 bedrooms and 2 and a half bathroom home. The primary child care areas are the following: The living room/ day care area, one hallway bathroom (located downstairs), the kitchen, the dining area, and the back fenced yard. The following areas are kept inaccessible with the use of locks or safety gates: 4 bedrooms and 2 bathrooms that are located on the second story and the attached garage. There are a sufficient amount of age appropriate toys, games, and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. The back yard is fully fenced and used for outdoor activities. The fire extinguisher is full, of regulation size, and located in the kitchen. There is no fireplace on the property. The smoke alarm and carbon monoxide monitor are operational. LPA Baez verified a working telephone, working email address, and all required forms are posted. There are no large bodies of water located on the property. Licensee stated that there are no firearms or ammunition on the property. LPA Baez verified that all adults living or working in the home have been fingerprint cleared and associated. LPA Baez reviewed children's files, child care roster, and emergency drill log. The last emergency drill was conducted on 09/2019. Licensee's pediatric CPR/FA certification expires on 02/2021.

LPA Baez reviewed physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, and new Safe Sleep regulations and Licensee stated that she understands. LPA reminded Licensee that walkers, jumpers, exersaucers, and bouncers are not permitted for use in the day care. Licensee was reminded that corporal punishment and smoking is not permitted at the day care. LPA Baez discussed Unusual incident reporting. New CDPH 286 form for "California Pre-Kindergarten & School Immunization Record" was discussed and will be provided by mail. ...CONTINUED ON PAGE 2...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LIZARRAGA, ELSA FAMILY CHILD CARE	FACILITY NUMBER: 136609662
	VISIT DATE: 10/18/2019

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Incidental Medical Services (IMS) was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation must be submitted to CCL prior to enrolling a child that requires IMS. 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 http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Facility is complaint with SB792.

LPA Baez discussed the Mandated Reporter training (AB1207). LPA Baez reminded Licensee that herself and all helpers are to take the training and have the printed certificates present at the facility and available for review. Training can be located at www.mandatedreporterca.com. Facility is compliant with AB1207.

LPA and Licensee discussed California Megan’s Law and LPA provided: www.meganslaw.ca.gov.

Notice of Site Visit is to be posted for 30 days.

No deficiencies were issued throughout today's inspection. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov. Duty Line: (619) 767-2248, Open Monday through Friday, 8am - 5pm

LPA's email: yolanda.baez@dss.ca.gov

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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