343623039-4-29-2019-03-CC-JBIK-BBPNH2-20190429102801

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623039
Report Date: 04/29/2019
Date Signed: 04/29/2019 10:28:16 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:	PERALES, ERESVEY		FACILITY NUMBER:	343623039
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	04/29/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Eresvey Perales		TIME COMPLETED:	10:40 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) Jeevun Birk-Miller and Amie Randa met with applicant, Eresvey Perales, for the purpose of an announced pre-licensing inspection. The applicant's husband and daughter were also present during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted inside and out. The facility is a two-story home with three bedrooms, two and half bathrooms, living room, dining room, play room, laundry room, garage, kitchen and fenced backyard. The off-limit areas are the entire upstairs, laundry room and garage. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The applicant acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa. The stair case to the upstairs was properly barricaded with a gate. The fireplace in the home is appropriately barricaded and applicant states the fire place will not be in use. Toxic and hazardous items are inaccessible to children. Safety latches are in use on some kitchen cabinets and drawers. The applicant understands that she must ensure the safety latches are not broken. Functioning smoke and carbon monoxide detectors and a 3A10BC fire extinguisher were observed in the home. Preventative Health, current pediatric CPR and first aid training was verified and expires 11/2019. Applicant stated there are no weapons in the home. There are no bodies of water on the premises. Applicant was encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. 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. Continue to 809-C page

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019

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: PERALES, ERESVEY	FACILITY NUMBER: 343623039
	VISIT DATE: 04/29/2019

NARRATIVE

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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. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochure. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates.

Effective today, 4/29/19, this home is licensed for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. Applicant stated she understands her two children are included in the ratio.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019

LIC809 (FAS) - (06/04)

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