313620783-6-22-2021-03-CC-KOWS-C48SL7-20210622135752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313620783
Report Date: 06/22/2021
Date Signed: 06/22/2021 01:58:00 PM

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:	CARRANZA, NINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 524-7084
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	14	CENSUS: 10	DATE:	06/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Nina Carranza - Licensee		TIME COMPLETED:	02:15 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	An announced annual/random inspection is made today by LPA Owens. Present at time of inspection were licensee, her niece and 10 day care children. Ages of children present were 5,6,9,6,4,10,3,6,2 and 7 years old. A tour of the home, inside and outside, as shown on the facility sketch is conducted. Staff and Children were spoken to during inspection. Licensee states there are no weapons or firearms in the home. The above ground swimming pool is fenced per regulation. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace is blocked by furniture making fire place inaccessible to day care children. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. There are no pets observed today. There are no stairs in the home. Toys and play equipment that were observed appear to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in any unfenced play area. LPA reviewed sleeping plan for each infant under 12 months old present. No infants under 12 months old present; no sleeping plans reviewed. The capacity as specified on the license is being maintained. (LARGE FCCH) Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 3/2023. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of inspection. LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792. 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: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: 06/22/2021

NARRATIVE

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

LPA discussed 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.

Off-limit rooms are: Garage and Master bedroom. Licensee acknowledges that children may never enter these off-limit areas. Swing set observed and is anchored into ground. Observed tool shed in backyard and it locked by key lock. During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7:00 AM to 4:30 PM; Monday thru Thursday and other hours as arranged.
Licensee states she does transport children.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee 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.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, NO deficiencies are observed today. This report was reviewed and discussed
with licensee at time of inspection. Licensee have read and understands the content of this report.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC809 (FAS) - (06/04)

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