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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618209
Report Date: 02/10/2022
Date Signed: 02/16/2022 01:42:50 PM


Document Has Been Signed on 02/16/2022 01:42 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:AVILA, GLIDAFACILITY NUMBER:
343618209
ADMINISTRATOR:AVILA, GLIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 420-5871
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:14CENSUS: 13DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Glida AvilaTIME COMPLETED:
02:05 PM
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At 12:20PM the home was toured inside and outside. The licensee and one assistant were supervising 13 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:30AM-5:30PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are upstairs and downstairs garage, and one bedroom. They were made inaccessible by locks and a gate. Poisons are locked in the garage. Items which could pose a danger to children. are stored out of the reach of children. The fireplace has been made inaccessible with an unreachable button. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection The home is clean, orderly, and comfortable. Stairs are barricaded with a mesh gate. There are safe toys and equipment available for children. There is a working telephone in the home. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. Ten children's records were reviewed at 12:40PM; required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunization's on file. The licensee has current pediatric CPR and First Aid certification, which expire on 8/2023. This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years. Notice of Site Visit shall be posted for 30 days from today's visit. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (916) 862-1086
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022
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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