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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623969
Report Date: 06/25/2021
Date Signed: 06/25/2021 04:18:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BECERRA, LAURAFACILITY NUMBER:
293623969
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/25/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Laura Becerra - LicenseeTIME COMPLETED:
04:45 PM
NARRATIVE
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On Friday, June 25th, 2021, at 3:02pm, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Laura Becerra, for a Prelicensing - Change of Location inspection. This is a single story, 3 bedroom, 2 bathroom home.

Licensee Rents the home and provided the appropriate forms.

The anticipated operating hours are 7:00am to 5:15pm, Monday through Friday, year around.

At 3:04pm, LPA initiated a health and safety inspection of all areas of the home as well as the outdoor area that will be used by the children in care.

Off-limits areas will include Front Bedrooms, Master Bathroom, Back Side Yard, Garage. Licensee acknowledged that children may never enter these off-limit areas.

There are stairs which are at the entrance to the home. The Licensee understands that before the front porch is to be used by the children in care, a barricade will be needed. The outdoor area used by children is fenced and age appropriate toys were observed. Applicant understands that 100% supervision is required in any unfenced areas or when away from the home if the nearby park is used. There are no bodies of water on the premises. Applicant stated there are no weapons in the home.

At this time, the Licensee does not carry liability insurance. LPA explained about obtaining a $300,000 annual aggregate/$100,000 per occurrence liability insurance policy. Licensee understands that until a policy is obtained, they must use the affidavit.

*Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969
VISIT DATE: 06/25/2021
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*Continuation of LIC 809
All adult residents received criminal record clearances. LPA reminded Licensee of the applicable Civil Penalty per person for those adults, including your own children, who have not received fingerprint clearances. LPA advised the Licensee of their responsibility to stay current with the requirements of the Department.

Licensee has certificates of completion for Preventative Health and Safety training including CPR/First Aid (expires: 9/2022) and Mandated Reporter Training.

Carbon monoxide and smoke detectors meet regulation. Hazardous cleaning compounds and medications are stored inaccessible and or out of children reach.

There is a gas fire place in the home that the Licensee states she will not be using. A Fireplace waiver will be issued to the Licensee.

At 3:30pm, LPA began to review Children’s files and other documentation that is required for operation of a day care. LPA reviewed the fire drill requirements.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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 link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

At 4:14pm, LPA reviewed and discussed this facility evaluation report with the Licensee.



Effective today (6-25-2021) the facility is licensed to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
LIC809 (FAS) - (06/04)
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