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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313593
Report Date: 05/09/2019
Date Signed: 05/09/2019 10:20:01 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:MALDONADO, SOCORROFACILITY NUMBER:
304313593
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/09/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Socorro Maldonado-ApplicantTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Andrea Taylor conducted a pre-licensing inspection in accordance with Title 22. A review of family member/staff records on this date indicates that all family members and/or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The applicant has two employees who need clearances transferred to her facility. LPA explained transfer of clearances to applicant.
LPA provided a list of the required forms for children's records. In addition, LPA reviewed requirements for posting Parent’s Rights poster with information regarding Megan's Law, Information regarding AB 633 and the requirements of documents to be provided to new parents and currently enrolled parents of Type A citations and administrative actions. In addition to the acknowledgement of receipt of reports form LIC9224. LPA advised of the new parent’s rights notification forms. LPA also provided information and instruction for reporting Unusual Incidents. LPA has provided the applicant with the web site (www.ccld.ca.gov) to enable access to all updated forms, requirements and changes. LPA advised the applicant of their responsibility to stay current in the requirements of the Department. Applicant stated that she is not planning to registered for Foster Care and does not operate any other licensed facility. LPA reviewed the fire drill requirements. The applicant has certificates of completion for 16 hours of health and safety training including CPR (exp:5/21) and First Aid (exp:5/21) that are EMSA certified. Home has working smoke detectors, carbon monoxide alarm, required fire extinguisher and a first aid kit. The home has fireplace is covered and inaccessible to children. Hazardous cleaning compounds are latched/locked or located on shelves that are inaccessible to children. Sharp utensils are latched and inaccessible to children. Medications are stored up high in an off limits area. The home contains appropriate toys for the children. All adult residents submitted fingerprint and child abuse forms.

The applicant had four children in care during inspection without having a license. The previous owner of the home had a license but has moved out of the home; therefore there is currently no active license for child care at this home.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: MALDONADO, SOCORRO
FACILITY NUMBER: 304313593
VISIT DATE: 05/09/2019
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Off limit areas include: garage, all bedrooms and bathrooms next to the bedrooms. Applicant acknowledges that children may never enter off-limit areas. The applicant understands that 100% supervision is needed when children are in an unfenced area. Applicant understands that prior to making alterations or additions to the home or grounds the licensee shall notify Licensing Agency per regulation 102416.3.

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org


Proof of immunization against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

An exit interview was completed. The report was reviewed and discussed. The applicant was provided a copy of appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: 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.htmttp://www.ada.gov/childqanda.htm

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.


English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MALDONADO, SOCORRO
FACILITY NUMBER: 304313593
VISIT DATE: 05/09/2019
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AAP: 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


· Always place infants on their backs for sleeping
· Use only a 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 or play 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 for an adult to wear a t-shirt and not be too hot or too cold

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3