313623374-1-2-2020-03-CC-JMCN-BKFNBJ-20200102091912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623374
Report Date: 01/02/2020
Date Signed: 01/02/2020 09:19:22 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:	PONCE, ROSANA		FACILITY NUMBER:	313623374
ADMINISTRATOR:	PONCE, ROSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 259-1888
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	14	CENSUS: 0	DATE:	01/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Rosana Ponce		TIME COMPLETED:	09:30 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	Licensing Program Analyst (LPA) Jeremey McClain met with applicant, Rosana Ponce, for the purpose of a pre-licensing, change of location inspection. A health and safety inspection was conducted inside and out of the home. The two-story home has an unfenced front yard, four bedrooms, three bathrooms, a living room, dining room, kitchen, garage, and fenced backyard. The off-limits areas in the home will be the entire upstairs, the laundry room, and the garage. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. There is a pool in the backyard that has a 5-foot-high fence with a self-latching and self-closing gate that opens away from the pool. The fireplace in the living room is appropriately barricaded to prevent access by children. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors, and a 2A10BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training was verified and expires 06/2021. Applicant stated there are no weapons in the home. Applicant was encouraged to maintain supervision at all times. Applicant has completed the required AB1207 Mandated Reporter training, which must be renewed on 03/2020. Applicant understands that the training must be completed once every two years, and that Mandated Reporter trainings offered outside of http://childcare.mandatedreporterca.com/ , must be approved by the department. REPORT CONTINUED ON THE FOLLOWING PAGE.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

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

FACILITY NAME: PONCE, ROSANA	FACILITY NUMBER: 313623374
	VISIT DATE: 01/02/2020

NARRATIVE

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Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that if anyone else works with the children, they must also obtain the following: EMSA certified CPR and first aid training, immunizations for measles Pertussis and Influenza, complete AB1207 Mandated Reporter Training, and complete eight hours of preventative health and safety training.
Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours.
Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.
Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area.
Applicant understands that children’s records are to be maintained according to Title 22 regulations, and be accessible to licensing for up to three years. Applicant understands that their License, Emergency Disaster Plan, and the Parents Rights Poster must be posted in the home.
Incidental Medical Services (IMS) policy was discussed. 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
This facility evaluation report was reviewed and discussed with the applicant. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list.
As of today, 01/02/2020, the home is approved for a Large Family Child Care Home license for a capacity of 12 children with no more than 4 infants; or up to 14 children with no more than 3 infants, with 2 children at least age 6. Infants are children under the age of 2.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

LIC809 (FAS) - (06/04)

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