343623165-10-17-2019-03-CC-KGUA-BH2U7X-20191017152039

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623165
Report Date: 10/17/2019
Date Signed: 10/17/2019 03:20:55 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:	FLORES, VICTORIA		FACILITY NUMBER:	343623165
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	10/17/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Victoria Flores		TIME COMPLETED:	03:40 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) Karyn Guerra met with Licensee, Victoria Flores, for the purpose of an unannounced case management inspection regarding an increase in capacity from 8 to 14 children. Licensee's spouse and children were also present during time of inspection. All individuals subject to a background review have obtained a criminal record clearance. Census at time of arrival was 3 preschool age children. LPA toured areas of the home accessible to the children. Off limits area of the home include the Master Bedroom (#2), Master Bathroom, Bedroom #1, Bedroom #4, Kitchen, and Garage. Licensee acknowledges that children must never enter these off-limit areas. LPA observed the required postings including license, Parent’s Rights Poster, and Emergency Disaster Plan. Current CPR/First Aid certification is available in the facility file, which expires 08/17/2021. LPA verified that annual fees are current. LPA observed all toxic and hazardous items are stored in areas inaccessible to children. There is no fireplace nor stairs in the home. Licensee stated there are no weapons in the home. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. The backyard is fenced. Pool is appropriately barricaded per Title 22 regulations. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Report continues on 809-C.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: FLORES, VICTORIA	FACILITY NUMBER: 343623165
	VISIT DATE: 10/17/2019

NARRATIVE

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Effective today, LPA Guerra will recommend increase in capacity from a small family child care home to a large family child care home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child is 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 revert back to the small capacity.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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