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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620412
Report Date: 01/22/2020
Date Signed: 01/22/2020 12:33:29 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:HERRERA, LOURDESFACILITY NUMBER:
343620412
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/22/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lourdes HerreraTIME COMPLETED:
11:15 AM
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LPA Kelly met with Licensee, at the family child care home for a case management visit for the purpose of increasing capacity from 8 to 14 children. This is a 2 story, 4 bedroom and 3 bath house. There were 4 day care children present.

Off limit areas: Entire second floor, son's bedroom on first floor, laundry room and garage.

All areas to be used for care were toured.

The home has a fire extinguisher, carbon monoxide and smoke alarm detectors are in compliance, there is also a wall alarm in the day care areas. There's also All soaps, detergents, sharp kitchen utensils, have been stored according to regulations. Licensee stated there are no firearms in the home. The backyard is fenced, there is locked shed for storage that is off-limit and there were no bodies of water. Applicant has current required 15 hours of preventative health training and proof of current 1st aid and CPR certificates. Adult residents have criminal record and Child Abuse Index clearances. LPA also reviewed the files of the children in care and found that applicant is presently using the required forms. LPA discussed Regulation 1597.622 (Employees and volunteer immunization) with licensee.

The Fire Safety Inspection Clearance has been received from the Fire Marshall and home has been cleared for up to 14 children on 1/14/20.

No deficiencies cited this date.

Effective date: 1/22/2020, Licensing office will grant a large license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will fall back to the small capacity.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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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