343623047-5-14-2019-03-CC-TWAN-BC6Q9Q-20190514115845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623047
Report Date: 05/14/2019
Date Signed: 05/14/2019 11:58:51 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:	RODRIQUES, ANITA		FACILITY NUMBER:	343623047
ADMINISTRATOR:	RODRIQUEZ,ANITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 752-6606
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 2	DATE:	05/14/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Anita Rodriques		TIME COMPLETED:	12:10 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	Licensing Program Analyst (LPA) Tanya Washington met with Licensee Anita Rodriques for the purpose of a pre-licensing/ change of location inspection, Licensee is also requesting a capacity increase which she has received an approval for from the Sacramento Metropolitan Fire Department on 04/29/2019. Licensee was previously licensed at facility #343622255. During today's inspection LPA observed care and supervision of 2 children. All individuals subject to criminal background review have obtained a criminal record clearance. LPA and Licensee toured the entire 2 story home both inside and out. The facility consists of 3 bedrooms and 2 bathrooms upstairs. Half bathroom, living room, dining room, garage and fenced front and back backyards downstairs. Off limit areas will consist of the entire second floor and garage. Applicant owns the home, LPA obtained a copy of the grant deed to show control of property. Applicant has completed the Preventative Health and Safety course which includes 1 hour of nutrition. Applicant's CPR and First aid certification expires November 15, 2020. LPA reviewed children's files and provided the Licensee with proposed Safe Sleep Regulation Concepts. 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

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: RODRIQUES, ANITA	FACILITY NUMBER: 343623047
	VISIT DATE: 05/14/2019

NARRATIVE

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LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. Licensee stated that there are no poisons in the home, LPA went over proper storage of poisons. Fire place located in the living room area will not be used during day-care hours. There are no bodies of water on the premises. Licensee stated that there are no weapons in the home.

Licensee has completed the required AB1207 Mandated Reporter training on 04/24/2019. Licensee understand that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com.

Licensee understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.
Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction.
This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Effective today's date, 05/14/2019, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection .
Exit interview conducted.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

LIC809 (FAS) - (06/04)

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