304313293-8-28-2019-06-CC-STOE-BFGUCF-20190828152752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313293
Report Date: 08/28/2019
Date Signed: 08/28/2019 03:27:57 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:	ESCALANTE, GENESIS		FACILITY NUMBER:	304313293
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	08/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Genesis Escalante		TIME COMPLETED:	03:45 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	An unannounced inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. LPA met with Genesis Escalante who guided analyst on a tour of the Early Childhood Setting indoors and outdoors. Also present was Eloida Escalante, licensee’s assistant. During today’s inspection, there was five children present. Licensee has a current children’s roster available. Licensee states that five adults live in the home. Operation hours are 6:00 a.m. to 7:30 p.m., Monday through Friday. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a single-story home which consist of four bedrooms, three bathrooms, kitchen, dining room, living room, front yard (fenced), and back yard (fenced). The licensee has designated the off-limit area as such; four bathrooms, two bathrooms, kitchen, dining room, living room, and front yard (fenced). The licensee has designated the daycare area as the following; family room (daycare room), add-on room (daycare room), one bathroom, and back yard. The daycare area was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning supplies, medication, and hazardous items that can pose a danger to children. Per licensee there are no weapons or firearms in the facility. There were age appropriate toys and learning material. Fire/disaster drill log was reviewed. Outdoor play activity is in the back yard. Licensee stated that she is always present when children are outside playing. The required fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector were in operable condition. First Aid kit was complete. Licensee and assistant have a current CPR/First Aid card with an expiration date of 10 /2020. Children's records: parents' rights and California School Immunization Record were reviewed.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ESCALANTE, GENESIS	FACILITY NUMBER: 304313293
	VISIT DATE: 08/28/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee and assistant have proof of immunization against pertussis, measles, and influenza. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee and assistant have completed the Mandated Reporter Training. Website provided: http://mandatedreporterca.com/. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. LPA provided licensee with the Effects of Lead Exposure handout.

During this inspection, there was no deficiency cited per CA Code of Regulations Title 22 Division 12.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

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