354415286-7-27-2020-07-CC-DVIA-BRWUND-20200727154345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354415286
Report Date: 07/27/2020
Date Signed: 07/27/2020 03:43:50 PM

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, ITSARIYABHORN		FACILITY NUMBER:	354415286
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	07/27/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Itsariyabhorn Robison		TIME COMPLETED:	03:12 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) Deanna Villagrana met with licensee Itsariyabhorn (Cherry) Robison via Facetime for a Case Management inspection for an increase of capacity to a large Family Child Care Home. Fire clearance was approved by the Hollister Fire Department on 07/22/2020. LPA explained the nature of today’s visit to Licensee. LPA observed six children including two infants with Licensee in the home. Two of the children are licensees. Present was also Licensee's husband Joel Robison. Days and hours of operation are Monday to Friday, 7:00am to 5:00pm. The adults that reside in the home are Licensee and her husband with two children ages 4 and 1 years old. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 07/27/2020 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation, and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately removes the individual and prevents them from returning to the home or having contact with children in care. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home was clean and orderly. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items were stored inaccessible to

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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, ITSARIYABHORN	FACILITY NUMBER: 354415286
	VISIT DATE: 07/27/2020

NARRATIVE

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children. LPA observed a fully charged 3A40BC fire extinguisher, a working smoke detector and a functioning carbon monoxide detector. Licensee stated there are no weapons/firearms in the home. LPA observed a barricaded fireplace in the living room. Off limit areas indoor: master bedroom/bath, two bedrooms, bathroom, kitchen and dining room. LPA observed a fenced backyard and no bodies of water. LPA observed the fenced off area to the right side of the home and back right corner of the backyard are inaccessible to children. Off limit areas outside the home: fenced off areas. LPA observed a large play structure in the backyard.

LPA observed Licensee has completed training on preventive health practices, and has current CPR and First Aid certification expiring 09/11/2021. Supervision of children was discussed with licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and that she must have an assistant when she exceeds the ratios for a small license. LPA Licensee understands that children cannot be left in parked vehicles unattended at any time if she transports children.

Department website: http://ccld.ca.gov provided to Licensee to review regulations and to download forms. Website for provider resources:https://cdss.ca.gov/inforesources/Child-Care-Licensing.

No deficiency was cited.

Notice of site visit was emailed to Licensee and must be posted for 30 days.

LPA conducted an exit interview with the licensee and advised her that a large Family Child Care Home license is approved pending Managers approval.

This report has been email to applicant and applicant will reply the email in lieu of a signature.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

LIC809 (FAS) - (06/04)

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