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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 12:45:47 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:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Kelly met with licensee for the purpose of an annual/random inspection. LPA toured the home inside and backyard. There were 4 day care children in care.

Off-limit areas: Entire second floor, son's bedroom on first floor, laundry room and garage.
Today, the home was inspected inside and out and the following was observed by LPA, all play areas were inspected:
-Knives, medications, first aid kit, and cleaning compounds were inaccessible to the children.
-LPA observed combination working Smoke, and a Carbon Monoxide detectors, and a fully charged 2A10BC fire extinguisher were in compliance.
-Current CPR/First Aid certificate.
-Backyard is fenced, free from apparent safety hazards, and there were no bodies of water
-The toys appear to be safe and in good condition
-All sharp knives are stored out of reach
-Fireplace is blocked
-Licensee stated there are no weapons/firearms in the home
-All adults in the home are fingerprint cleared
-Cleaning compounds are stored out of reach of children
-The bathroom was free of any hazardous items
-Medication are out of reach of children
-Posted license, parents rights, and emergency disaster plan
-LPA reviewed children's record, roster and fire drills documentation
--LPA discussed and reviewed Health & Safety code: 1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions with licensee. 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 and the ADA, available at: http://www.ada.gov/childqanda.htm
-There is a working telephone in the home
-LPA did not observed children alone in parked car
-Provided licensee with website www.ccld.ca.gov to obtain forms and Title 22 Regulations.

Home was in compliance at time of inspection
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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