376628259-5-6-2019-20-CC-GCRZ-BBWQ64-20190506115255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628259
Report Date: 05/06/2019
Date Signed: 05/06/2019 11:53:04 AM

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:	CENIZO, LIDIETTE FAMILY CHILD CARE		FACILITY NUMBER:	376628259
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	05/06/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lidiette Cenizo		TIME COMPLETED:	12:30 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	LPA, Gloria Cruz conducted a change of location pre-licensing inspection of the home with the applicant, Lidiette Cenizo. Purpose of the visit is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3. The two story, three Bedroom 2 1/2 bath home was toured and inspected to ensure a safe and healthful environment for children. Applicant provided copy of lease agreement as proof of occupancy. The fire extinguisher, smoke detector (wired), and carbon monoxide detector are operational and there are no weapons or bodies of water within the home. Applicant has completed the required 16 hours of preventative health training. CPR and first aid certifications are valid through April 2021. The applicant will be using the entire downstairs, living room, family room, dining room, kitchen and downstairs bathroom. Off limit areas include the entire upstairs and garage which are made inaccessible to children by door knob covers and stairs barricaded. Applicant was reminded that direct supervision must be provided at all times during outdoor play. All poisons and cleaners and hazardous items are inaccessible to children, electrical outlets are covered and window cords kept out of reach. Required documents are posted. All adults in the facility have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Per applicant operating hours are from 7 a.m. to 6 p.m. Mon – Fri. LPA reviewed supervision, emergency drills, required children's records, unusual incidents reporting, mandated reporting, SIDS, and Shaken Baby Syndrome, copy of American Academy of Pediatrics pamphlet was provided. Applicant is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day-care operation. Advised no changes should be made to home without prior notice and/or approval from Licensing. To register for Quarterly Updates, email Childcareadvocatesprogram@dss.ca.gov

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 767-2250
LICENSING EVALUATOR NAME: Gloria Cruz	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

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: CENIZO, LIDIETTE FAMILY CHILD CARE	FACILITY NUMBER: 376628259
	VISIT DATE: 05/06/2019

NARRATIVE

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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

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov

Applicant states she will comply with all regulations and laws governing family child care homes. Applicant confirms that she is financially secure to operate a family child care home for children.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 767-2250
LICENSING EVALUATOR NAME: Gloria Cruz	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

LIC809 (FAS) - (06/04)

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