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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313549
Report Date: 10/01/2020
Date Signed: 10/01/2020 10:41:06 AM

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:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/01/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Fernando Rasika TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Ketki Desai conducted a Case Management – Licensee initiated (Capacity increase) inspection today. LPA met with License Fernando, Rasika in person it was an announced inspection, upon arrival licensee guided analyst on a tour of the home.
There were 2 preschool age children receiving care and supervision at the time of arrival.
A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Per Licensee, family members residing in the home are one adult and one minor. Licensee is requesting a Large family childcare home license. Per Licensee, operating hours will be Monday to Sunday : 23 hours/day Licensee states that she will care for children ages 8 weeks to 12 years of age.
All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single, -story home that consists of three bedrooms, two bathrooms, living room, kitchen, dining room, sun room, attached garage, front yard, and backyard that is fenced. There are no stairway in the home.

Areas designated to Day care activities : Dining area, sun room, (enclosed patio converted into a Day care room) and bathroom that is on left side as one enters the dining room are used for childcare. There is a side door on the backyard to use only for day-care business. Dining area is converted into a Day care activity room size and age appropriate activities and furniture were observed. the sun room is designated mainly for table top and educational activities, the converted dining area is used during napping time, children nap on the cots, linens are provided by the licensee and blankets or sleeping bags are provided by the parents.

Off Limits areas: Three bedrooms/ one bathroom / living area / Kitchen.
There are child safety gates installed in the living room and kitchen making it inaccessible to children.
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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
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 4
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: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 10/01/2020
NARRATIVE
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There is a fire place in the living area, inaccessible to children, Licensee has placed a safety barrier in front of the fire place.
Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a center air and heat. A/C unit is placed in the backyard a safety barrier has been installed around it making it inaccessible to children.

OUTDOOR PLAY AREA: Back yard is fenced from all the sides, it also has a shaded patio area and grassy area where outdoor toys there is one climbing structure placed on grass area. There were no hazardous observed. There is a locked shed for storage purposes, made inaccessible to children.



Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Licensee states (that there are no poisons on the premises).

Per Licensee there are no firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children. cots are used during napping time, linens and blankets are provided by the parents. Young infants nap in the play pens/ cribs. There is also a changing station for young infants and toddlers.

The Licensee provides food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.

The Licensee has completed the required Pediatric First Aid and CPR which expires 4/25/2021. There are first aid supplies available.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
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: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 10/01/2020
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The following items were also discussed with licensee during this inspection.

All homes shall conduct fire and disaster drills at least once every six months and document the drills.

PETS: There is are no pets in the home.

POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted.

PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family childcare facility.

SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

UPDATE: H&S 1597.622: Commencing September 1, 2016, 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. The licensee have submitted the proof of immunization.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com


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 (Page -3)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 10/01/2020
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LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.
LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

Capacity Handout (Small & Large) was provided via email to the licensee

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

Currently, the licensee is in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

Appeal Rights and Notice of site visit was issued on today's inspection.

No deficiency cited during today's inspection.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4