313620783-2-26-2021-03-CC-KOWS-BYLNW3-20210226094852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313620783
Report Date: 02/26/2021
Date Signed: 02/26/2021 09:51:17 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:	CARRANZA, NINA		FACILITY NUMBER:	313620783
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	02/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Nina Carranza - Licensee		TIME COMPLETED:	10:30 AM

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 announced *case management - capacity increase from 8 to 14* children tele-visit via Face-time was conducted by Licensing Program Analyst Owens due to COVID-19. LPA Owens conducted the tele-visit with applicant, Nina Carranza. LPA toured all areas of the home via face-time. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit. Applicant has certificates of completion for 15 hours of health and safety training including current CPR and First Aid. All adult residents received criminal record clearances. LPA reminded applicant of the applicable Civil Penalty per person for those adults including your own child who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. Applicant understands that she needs to notify licensing for any modification inside and out of the home. There is a shed in the backyard that is locked. The fire clearance was approved on 2/22/2021. Off-limit areas include Master bedroom/bathroom, Garage and side yard gated. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The fire place is inaccessible to day care children. Applicant stated there are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced and there are no bodies of water. Applicant understands that 100% supervision is required in any unfenced areas. There is no pool at the home at this time. There are no pets at the home. There are no stairs at the home. Planned hours of operation are Monday through Thursday, 7:00 am to 4:30 pm and other hours as arranged. continued on page 2.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CARRANZA, NINA	FACILITY NUMBER: 313620783
	VISIT DATE: 02/26/2021

NARRATIVE

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LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of visit. LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com.

LPA discussed the new Safe Sleep in Child Care regulations. LPA discussed and gave licensee the Effects of Lead Exposure brochure.

This facility provides Incidental medical services-IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the applicant can obtain updated licensing information, new regulations and access forms. LPA advised applicant of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Effective today 2/26/2021 applicant is a license to serve up to either 14 children, (WHEN THERE IS AN ASSISTANT PRESENT), 12 children -No more than 4 infants. Capacity 14 - No more than 3 infants. 1 Child in Kindergarten or Elementary school and 1 child at least age 6.

Exit interview were conducted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021

LIC809 (FAS) - (06/04)

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