173009993-2-16-2021-01-CC-LROS-BYB2XM-20210216164723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 173009993
Report Date: 12/14/2020
Date Signed: 02/16/2021 04:47:29 PM

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:	ALVAREZ RAMOS, ROSA FCCH		FACILITY NUMBER:	173009993
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	12/14/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rosa Alvarez-Ramos		TIME COMPLETED:	02:00 PM

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 Facetime video conference Tele Pre-Licensing inspection was conducted today by Licensing Program Analysts (LPA), Leticia Rosales-Meza. The applicant is Spanish speaking. Due to the COVID-19, the Department has suspended all field operations, and the applicant agreed to attend the video conference with LPA. The applicant is requesting a license for a capacity of 8. Services will be provided Monday - Friday 6:00 AM - 6:00 PM. The applicant understands that 24hr consecutive care is prohibited. The applicant understand that childcare must be provided in the "primary" residence of the applicant. The residence is a five bedroom two bath mobile home. 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. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. 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. During the Tele-Inspection, the applicant provided a virtual tour of the entire facility and backyard. The day care space is the living room, dining room, one bedroom and bathroom. The three bedrooms and laundry room are "off limits" to the day children, and were made inaccessible by door knob covers and key locked doors. The floor plan submitted by the licensee was reviewed and verified. During the video LPA observed electrical outlets were covered and drapery cords are not accessible. 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 (detergents, cleaning compounds, and medications) were stored out of the reach of children. Latches are used underneath the sinks of kitchen and bathroom cabinets. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The applicant states there are no Firearms or Weapons and none were observed during today's Tele-Inspection. Applicant stated there are no poisons in the home. The requirement that poisons be stored in a space locked with a key lock/combination lock is reviewed. First Aid supplies are kept in the living room. The children in care will have access to age appropriate toys and equipment. The mobile home has central heating and cooled by a window air conditioning unit. The children will use the side carport area of the mobile home as the outdoor play. The children will also be taken to a nearby neighborhood park for outdoor play. There is no trampoline, pool, pond, or fountain.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

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: ALVAREZ RAMOS, ROSA FCCH	FACILITY NUMBER: 173009993
	VISIT DATE: 12/14/2020

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

Incidental Medical Services 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.

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. CPR and First Aid cards expire 08/2022. 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 must be obtained from the website. http://ccld.ca.gov/ Megan's Law web site 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 applicant's signature was not recorded on this Facility Evaluation Report (LIC 809 & LIC 809-C), however, the applicant was provided with a copy of this report; and the applicant's proof of Read Receipt is on file. LPA also mailed a copy of this report to the applicant. A Pre-Licensing Packet (documents) were provided to applicant.

Based on this video inspection, the facility meets licensing requirements. The license is granted and is now licensed as a Small Family Child Care Home.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2