334845518-6-16-2021-10-CC-OCAN-C42UQV-20210616154746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845518
Report Date: 06/16/2021
Date Signed: 06/16/2021 03:47:59 PM

Document Has Been Signed on 06/16/2021 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	ROCHA-HOLLIS FAMILY CHILD CARE		FACILITY NUMBER:	334845518
ADMINISTRATOR:	ROCHA, KYLEE & HOLLIS, BRI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 898-7323
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	06/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Kylee Rocha and Bri Hollis- Licensees		TIME COMPLETED:	04:07 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	1) On date and time listed, Licensing Program Analyst (LPA) arrived at the facility to conduct a Required – 1 year inspection. LPA toured the facility, inside and out, records were reviewed and the following was observed and/or discussed: Normal days and hours of operation are: Monday through Friday 7:00a to 5:00p OFF-LIMIT AREAS INCLUDE: Complete Upstairs, Kitchen, living room. LPA observed care provided in a converted Garage that was approved with fire inspection. · The facility is operating within the licensed capacity and appropriate ratios · The Licensee is present in the home and has ensured that children in care are supervised at this time · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children · A working telephone is present · Appropriate fire extinguisher, smoke detector and carbon monoxide detector is present and were tested by the applicant during this inspection. · All hazardous items are inaccessible, this includes: detergents, cleaning compounds, medications and other items which could pose a danger to children · Storage of poisons is inaccessible to children and locked · There is a properly barricaded fire place · No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 regulations.

SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ROCHA-HOLLIS FAMILY CHILD CARE	FACILITY NUMBER: 334845518
	VISIT DATE: 06/16/2021

NARRATIVE

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· The Department was granted inspection authority as required by the Health and Safety Code
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

During the exit interview, the LICENSEES, Bri Hollis and Kylee Rocha, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ROCHA-HOLLIS FAMILY CHILD CARE	FACILITY NUMBER: 334845518
	VISIT DATE: 06/16/2021

NARRATIVE

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· Stairs are barricaded at this time.
· Home is clean and orderly, with heating and ventilation for safety and comfort
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced or appropriate supervision is present
· Verification of control of property on file
· Property owner/landlord notification and consent on file
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Pediatric CPR and First Aid Card - expired on 02/2021 and 04/2021. Licensee Bri has taken an additional CPR certification that expires 7/2022
· Health & Safety Certificate - completed on 04/22/2018
· There are no bodies of water, at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys
· Documentation of fire drills on file Last conducted 6/7/21
· Each child’s file contains a copy of the emergency information card with required information
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 6/15/21.

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

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