304313602-11-25-2020-06-CC-KDEI-BVPV99-20201125151357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313602
Report Date: 11/18/2020
Date Signed: 11/25/2020 03:14:13 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:	COTA, YOLANDA		FACILITY NUMBER:	304313602
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	11/18/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee Cota Yolanda		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced In-person Case Management License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Cota, Yolanda, who guided analyst on a tour of the home. At the time of arrival 2 adults were observed providing care and supervision to children present at the Family Child Care home. A review of the Facility Personnel Report Summary dated (11/17/20) indicates adults, residing in the home who require caregiver background check clearances are cleared Licensee is requesting a Large family childcare home license. She has been a provider since May 2019, Licensee was operating under the Blanket Waiver and upon application for a Large Family Child Care home the new Fire clearance was requested and received on 10/30/20 with specific instruction indicating second level of the home is not approved for Day care. Per Licensee, operation hours will be Monday to Saturday, 5.00 AM to 4.00 AM, care and supervision shall be provided to children ages. (1 month -13 years of age). Licensee stated she is currently registered with Foster Care agency and holds a foster parent license, with County of Orange Social Services Agency Children & Family Services Division, Effective License date was January 3rd 2020 . Licensee is an approved Resource Parent and has a foster child in care. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story apartment home with 3 bedrooms and 1 ½ bathrooms, living area, Dining and kitchen. Licensee has designated the following areas of the home as off limits and inaccessible to children: the upstairs floor, all 3 bedrooms and one full bathroom. The detached garage located in the parking area that is off limits to the children. (page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
	VISIT DATE: 11/18/2020

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air system, the A/C unit is installed in the area inaccessible to children in the back yard, there is a wall mounted heater in the living area with a safety barrier across it. Kitchen is open , Licensee has installed child safety locks on all the cabinets making it safe for children in care. The children's bathroom is located besides the pantry area with a safety gate. There is a stairway in the home, a child safety gate has been installed making it inaccessible to the children.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

LPA also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

Areas Designated for Day care activities: Children shall enter the home through the main door of the home, there is sanitizer dispenser, with sign in table at the side of the main entrance door, upon entering temperatures are checked, children remove their shoes and in home shoes are worn, no outside visitors are allowed at this time. The Licensee has designated the living area (Classroom area), first floor half bathroom and backyard as part of the childcare. Living area is divided into sections one side is turned into a napping area and other side is the activity area, Young infants nap in the cribs and older children nap on the mats, linens are provided by the parents and all infants needs are also provided by the parents.

It has age appropriate toys and educational material for children.

The designated Day care bathroom was observed to be safe and free of hazardous items.

Licensee provides daily breakfast/ Lunch and snacks to enrolled children. Water is provided by Licensee;

OUTDOOR PLAY AREA: Licensee has assigned the back yard for outdoor activities, it is completely fenced with concrete flooring, It was observed to be safe with outdoor toys.

(2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
	VISIT DATE: 11/18/2020

NARRATIVE

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Per licensee, there are no pets, 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.

Licensee have completed the required Health and Safety with Lead and Nutrition training and Pediatric First Aid and CPR which expires on March 2021. There are first aid supplies available.

This is gated apartment complex, parent have access through the back side of the complex. Licensee has a cell phone that is used for childcare. Licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Civil Penalties will be assessed if not in compliance.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
(3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
	VISIT DATE: 11/18/2020

NARRATIVE

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Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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 has submitted proof of immunization's.

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): 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 Family Child Care Homes Section 102417. 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 states, currently there are no enrolled children receiving this treatment .

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)

 Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Orange County Fire authority have granted the fire clearance with specific instructions: Garage & second level of the home are not approved for Childcare (4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
	VISIT DATE: 11/18/2020

NARRATIVE

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The licensee does have a current roster of children in care. Children’s records for children present during LPA's inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LPA reviewed 2 children’s file

The facility was in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the applicant will be notified.

On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

LIC809 (FAS) - (06/04)

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