136610451-9-30-2019-20-CC-YBAZ-BGHS9J-20190930134049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136610451
Report Date: 09/30/2019
Date Signed: 09/30/2019 01:40:59 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:	RODRIGUEZ, IMELDA & DANIA		FACILITY NUMBER:	136610451
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	09/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Imelda Rodriguez		TIME COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct an annual inspection. LPA Baez met with Licensee, Imelda Rodriguez. There was 1 child present at the time of the inspection (1 infant).

LPA Baez toured the home. This is a two story, 5 bedroom, and 3 bathroom home. The following areas are accessible to the children in care: the living room near the main entrance, the second living room near the dining area, the dining area, the hallway bathroom, and the back yard. The following areas have been made inaccessible through the use of door knobs or safety gates: the entire upstairs (includes 5 bedrooms and 2 upstairs bathrooms), the kitchen, 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 a fireplace on the property and it is properly kept inaccessible to the day care children. The smoke alarm and carbon monoxide monitor are operational. LPA Baez verified a working telephone and all required forms are posted. There are no large bodies of water on the property. Licensee stated that there are not any firearms and 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 09/09/2019. Licensee's pediatric CPR/FA certification expires on 12/2019.

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 provided and discussed.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2019

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: RODRIGUEZ, IMELDA & DANIA	FACILITY NUMBER: 136610451
	VISIT DATE: 09/30/2019

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IMS was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation needs to be submitted prior to enrolling any 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. Licensee is compliant 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. Licensee is compliant with AB1207.

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

A fire clearance for capacity of 14 children was granted on 08/21/19. A large family child care license will be issued effective today.

There were not any deficiencies issued throughout today's inspection. Notice of Site Visit is to be posted for 30 days, LPA observed Licensee posting the Notice of Site Visit.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2019

LIC809 (FAS) - (06/04)

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