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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173002029
Report Date: 10/08/2021
Date Signed: 10/08/2021 11:07:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:CABREROS, CATHY FAMILY CHILD CARE HOMEFACILITY NUMBER:
173002029
ADMINISTRATOR:CABREROS, CATHYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 994-9146
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 4DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Cathy Cabreros, LicenseeTIME COMPLETED:
11:20 AM
NARRATIVE
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A Required- 1 year inspection was made to the facility by Licensing Program Analyst (LPA) Kevin O'Connell. A review of staff records on 10/08/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are two adults living in the home.
During today’s inspection the home and grounds were toured.
The licensee and an assistant were supervising four children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are Monday - Friday; 07:00am - 10:00pm.
Childcare areas are kitchen, living/dining room and one bathroom. The outdoor area is the back yard which is fully fenced. The off-limits areas are the garage, three bedrooms and laundry room, made inaccessible by door locks.
The back yard is fully fenced and used for outdoor play. The home was clean and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The Licensee has current pediatric CPR and First Aid certifications which expires 03/23. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Licensee states that there are no poisons but can key lock them in the laundry room.
There is no fireplace. There is a working smoke detector & carbon monoxide detector. The sole fire extinguisher was not charged when checked and was last serviced 9/2018. Licensee states that there are no firearms or dangerous weapons and none were observed. The Licensee states that there are no pools, spas, or water features and none were observed.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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,
, CA
FACILITY NAME: CABREROS, CATHY FAMILY CHILD CARE HOME
FACILITY NUMBER: 173002029
VISIT DATE: 10/08/2021
NARRATIVE
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Two staff files were reviewed at 10:05am for Mandated Reporter Certificates and immunizations. Four children's records were reviewed at 09:55am; required emergency information cards were observed to be on file. No children need or are receiving Incidental Medical Services at this time.
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 was 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.

See LIC809D for Title 22 violation.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CABREROS, CATHY FAMILY CHILD CARE HOME
FACILITY NUMBER: 173002029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2021
Section Cited

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:

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(1) Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This requirement has not been met as evidence by: LPA observed at 10:15am on 10/8/21 that the sole fire extinguisher in the kitchen was in need of recharge. The Licensee acknowledged this and stated that there is no other fire extinguisher at the facility.
This poses a potential health and safety risk to children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3