173009884-5-7-2020-01-CC-NCUM-BPDLXJ-20200507090845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 173009884
Report Date: 05/04/2020
Date Signed: 05/07/2020 09:08:58 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	RIVERA, ELIZABETH FCCH		FACILITY NUMBER:	173009884
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/04/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Elizabeth Rivera, Applicant		TIME COMPLETED:	11:50 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	A pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) N. Cunningham. The applicant is requesting a license for a capacity of eight children. Child care will be provided in the living room, kitchen, dining room, playroom, day care bathroom, and fully fenced backyard. Facility hours will be 7:00 a.m. - 6:00 p.m. Monday - Friday, year-round. The applicant understands that 24-hour consecutive care is prohibited. There are two adults living in the home. 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. The floor plans are verified. The home's bedrooms, laundry room and master bathroom "off limits" to the day care children. These areas have been made inaccessible by door locks. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home. Items which could pose a danger to children such as sharp knives, cleaning supplies, and medicines, are stored out of the reach of children in the upper reaches of the facility kitchen. The applicant stated there are no firearms or other weapons in the home, and none were observed during this inspection. Applicant stated no poisons are stored on the property, and none were observed during this inspection. The First Aid supplies are kept in the hall closet and in the playroom a locked cupboard in the hallway. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A 10:BC. Incidental Medical Services (IMS) regulations were reviewed with the applicant. The applicant understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department. Continued on LIC 809-C.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: RIVERA, ELIZABETH FCCH	FACILITY NUMBER: 173009884
	VISIT DATE: 05/04/2020

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
26
27
28
29
30
31
32

Continued from LIC 809.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are 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. Licensee's CPR and First Aid cards expire in 09/2021.

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. Infants or children shall not be allowed to sleep in car carriers in the home. 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 any area where child care is provided. The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations may be obtained from the website http://ccld.ca.gov/ Megan's Law web site information was provided (http://www.meganslaw.ca.gov).

The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The license will be effective as of 05/05/2020.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2