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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310483
Report Date: 07/15/2021
Date Signed: 07/15/2021 04:14:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FONSECA, ROSAFACILITY NUMBER:
304310483
ADMINISTRATOR:FONSECA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 557-1394
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:14CENSUS: 9DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Licensee - Rosa FonsecaTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Corral conducted an on-site inspection for the purpose of an Annual Inspection. The COVID 19 Health Questionnaire was reviewed and answered by Licensee prior to entering the Facility. LPA Corral and Licensee Rosa toured the inside and outside of the classroom. There were 9 children present in care which included 4 preschool children, 4 school age children and 1 infant with 1 assistant and Licensee providing care and supervision. Licensee's Adult Daughter was also present in the Facility. Due to COVID 19 Guidelines, LPA Corral observed assistants and children wearing face masks, social distancing and following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are Monday – Friday, 8 a.m.- 4 p.m. A review of the Facility Personnel Report Summary conducted on 07/13/2021 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children such as detergents, cleaning compounds, and medications were observed to be stored out of the reach of children above 5 feet high and locked away above the refrigerator. Poisons/Hazardous items are not kept on the premises. The rooms available for care are the main play room located after the living room, the bathroom which is located next to the main play room, the infant room that is located to the left of the entrance of the home and the backyard. The bathroom was observed to be clean and sanitary. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. The fireplace located in the living room was screened to prevent children access. The home provided safe toys, play equipment and materials. Drinking water is available for children by the use of the disposable water cups that are discarded after use. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Bodies of water and firearms were not present or observed to be in the home during inspection. There is also working telephone service by use of a home and a cell phone.
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FONSECA, ROSA
FACILITY NUMBER: 304310483
VISIT DATE: 07/15/2021
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Staff files were reviewed for the staff present during the facility inspection. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles and influenza for Licensee and the Assistant were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. Licensee and Assistant were in compliance with mandated reporting training, Licensee Rosa completed her Mandated Reporter on 03/04/2020. Licensee's Pediatric CPR/First Aid certification expires on 03/01/2022. LPA Corral also reviewed Children's Records. Each child’s record contained information of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or someone who can assume responsibility for the child if the authorized representative cannot be reached.

LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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. The backyard was inspected which was enclosed by a gate and there was also an adult present providing care and supervision for the children. The outdoor equipment and toys were in good repair and free of sharp edges. The home was kept clean and orderly with heating and ventilation for safety and comfort.

There was a play yard present in the infant room, the play yard was free from loose articles and objects. Licensee provides supervision while infant is sleeping. Licensee maintains a Sleeping Log which includes date, infant's name and time of check. Licensee stated the infant is physically check every 15 minutes during sleep and LPA Corral observed Assistant Griselda providing infant care.

Licensee Rosa was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov, she was also informed she may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov.
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FONSECA, ROSA
FACILITY NUMBER: 304310483
VISIT DATE: 07/15/2021
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LPA Corral provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian Information on nutrition training, immunization requirements for children, and Health Schools Acthttp://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. Director was informed about the California Child Care Disaster Planwebsite: cchp.ucsf.edu/content/disaster-preparedness LPA Corral also provided information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure will be emailed.

LPA Corral provided with a copy of the Provider Information Notice (PIN) 20-06-CCP Social and Physical Distancing Guidance. Director was provided with a Copy of the 2016 “A Child Care Providers Guild to Safe Sleep”
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Director was informed of the following:
· Always place infants on their backs for sleeping, use tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib, keep all items, including blankets, out of the crib yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough to wear a t-shirt not too hot or too cold

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

LPA Corral conducted an Exit Interview with Licensee Rosa. The report was read, reviewed and discussed with Licensee, Appeal Rights were explained, Rosa was provided a copy of Appeal Rights (LIC 9058) and signature on this form acknowledges receipt of these rights. Licensee was informed all appeals must be in writing and received by the Regional Office within 15 business days. Notice of Site Visit was provided and posted by Licensee. Rosa was informed the Notice of Site Visit must be posted for 30 consecutive days and failure to post will result in a Civil Penalty of $100.00.
End of Report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3