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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313611358
Report Date: 06/10/2021
Date Signed: 06/10/2021 11:43:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PENA DE LICATA, ROSAFACILITY NUMBER:
313611358
ADMINISTRATOR:PEÑA DE LICATA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 408-7838
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 12DATE:
06/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Paul LicataTIME COMPLETED:
12:00 PM
NARRATIVE
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At 10:15am, Licensing Program Analyst (LPA) Amanda Blesi met with the Licensee's spouse, Paul Licata, for the purpose of an unannounced Annual inspection. The Licensee Rosa is out of town during today's visit. Assistant, Obdulia (Gigi) Alvarez was also present upon arrival. LPA asked if anyone else was present in the home today and licensee stated his adult son is visiting from college. LPA advised if he is visiting long term (more than 2 weeks) he should be fingerprint cleared. Today’s census was 2 infants over 12 months and 10 preschool children.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the upstairs and garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a working phone and fire extinguisher. The smoke detector and carbon monoxide detector were tested and observed to be functioning. Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) were not properly stored upon arrival. The fireplace in the home is appropriately barricaded to prevent access by children. Stairs were barricaded. Safe toys and play equipment are observed. The outdoor play space is fenced. The backyard is fenced and gated. There is an above ground hot tub observed to be covered and locked on all four corners. Report is continued on the following page LIC 809-C...
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358
VISIT DATE: 06/10/2021
NARRATIVE
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Six children’s files were reviewed for Emergency card information using KIT #1. CPR and first aid training were verified and expire 7/2021.

Incidental Medical Services (IMS) policy was discussed. 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.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the Licensee can request to be added to the distribution list to receive Quarterly Updates.

LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792. Assistant did not have proof of immunization.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com. Licensee was advised the Mandated Reporter Training (AB1207) shall be renewed every two years. All staff need to renew their mandated reporter training.


LPA reviewed and discussed this facility evaluation report with the Paul and a copy of this report was provided . LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at http://ccld.ca.gov for childcare updates, current forms, legislation and regulation information.



Per California Code of Regulations, Title 22, Division 12, Chapter 1, one Type A deficiency is cited during today's inspection. The deficiency has been cited on the attached LIC 809 D. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file. Appeal Rights were provided.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/11/2021
Section Cited

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Poisons shall be locked.
This requirement was not met when LPA observed cleaning supplies under the kitchen sink (bleach, pledge and cleaners). The storage area did not have child safety locks making the items accessible to children. In addition, poisons such as Raid and weed killer were stored in the locked garage however the items were not locked in and individual storage area. These items pose an immediate health and safety risk to children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2021
Section Cited

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 On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement was not met. LPA observed expired Mandated reporter certificates for all staff. This is a potential health and safety risk to children in care.
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Type B
06/24/2021
Section Cited

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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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement was not met when LPA did not observe the assistant Gigi immunizations to measlese, pertussis or flu.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2021
LIC809 (FAS) - (06/04)
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