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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616984
Report Date: 07/02/2019
Date Signed: 07/02/2019 02:58:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SANDOVAL, IRMA FAMILY CHILD CAREFACILITY NUMBER:
376616984
ADMINISTRATOR:SANDOVAL, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 296-7446
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 13DATE:
07/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Irma SandovalTIME COMPLETED:
03:15 PM
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An unannounced random inspection was conducted today. Upon arrival LPA observed 13 children in care with the licensee and helper Blanca Arellano Reyes. Children were napping in the living room and daycare room. There were 3 children under age two and two school-age children in the group. LPA conducted a tour of the home to ensure the health and safety of children. Licensee is using the following areas for daycare: living room, dining, kitchen, bedroom across from the bathroom, hallway bathroom and back fenced yard. The following areas are off-limits to children: Office and Master bedroom. These areas are inaccessible to children via barricade and a door knob cover.

There were no bodies of water observed today. Ms. Sandoval stated that she does not maintain any weapons. All cleaners, toxics, and other hazardous substances are inaccessible to children in care via storage in the garage. Fire extinguisher, carbon monoxide and smoke detectors are present in the home. The home is kept clean and orderly with sufficient ventilation for safety and comfort. The home provides toys, play equipment and materials. The home maintains a working telephone service.
Outdoor play areas are fenced. The licensee maintains a current children’s roster. Facility conducted an emergency disaster drill on February 4, 2019 (once every six months); documentation of the date and time of drill was observed. The licensee and other personnel has completed training on Preventative Health Practices including Pediatric CPR and First aid. Licensee’s CPR & First Aid certificate are valid through March 2021.

Facility has not exceeded the capacity specified on the license. There are no new adults living or working in the home over the age of 18 years. All individuals subject to criminal record review have obtained criminal record clearance or exemption prior to working, residing or volunteering.

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SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SANDOVAL, IRMA FAMILY CHILD CARE
FACILITY NUMBER: 376616984
VISIT DATE: 07/02/2019
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Ms. Sandoval provided the LPA a copy of her current Children's Roster (form LIC 9040).

Ms. Sandoval shall submit a Plan of Operation no later than July 20, 2019 for the Incidental Medical services that she is providing. Ms. Sandoval is maintaining an Epi-pen for one of the children in care.

NO DEFICIENCY OBSERVED TODAY.



LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.


Community Care Licensing WEBSITE: http://www.ccld.ca.gov
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
LIC809 (FAS) - (06/04)
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