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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354415286
Report Date: 06/30/2020
Date Signed: 07/02/2020 08:22:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROBISON, ITSARIYABHORNFACILITY NUMBER:
354415286
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
06/30/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Itsariyabhorn RobisonTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Itsariyabhorn Robison (Cherry) for a Case Management inspection via Facetime for deficiencies cited on 03/04/2020. Present were licensee, licensee's husband and her two children. Licensee stated she did not have any daycare children today.

LPA observed the kitchen, dining area and bedrooms are closed off by baby gate and inaccessible to children. All bottom kitchen cabinets have locks on them to make inaccessible to children. LPA observed a new entry door from the living room into the side playroom. Licensee stated she was informed to add a second exit for children and also add a step so children can easily access window in case of an emergency. LPA observed the wall heater was removed in playroom and a new electric panel was installed. LPA observed a new fire extinguisher in the playroom with a current tag on it. LPA observed the children's bathroom cabinet is locked and cleaning supplies and medications were inaccessible to children. LPA toured the backyard and observed the play structure was fixed and had sufficient resilient material under it. LPA observed the back right side corner was fenced off and inaccessible to children. LPA did not observe any extension cords. The right side patio is fenced off an inaccessible to children. LPA did not observe any bouncers or similar items in or outside of the home. The fish tank was removed and the patio was cleaned and made more to look like a play area for children. The orange tree that was low and could cause a potential hazard to children was trimmed and made safe.

There were no deficiencies cited during visit. LPA requested a copy of the roster be emailed to LPA and to also submit a new facility sketch to include new entry into playroom.

Notice of site visit was issued by email and must be posted for 30 days.
This report has been emailed to licensee and licensee will reply to the email in lieu of a signature.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2020
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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