376628433-10-4-2019-20-CC-ERIA-BGMN97-20191004101528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628433
Report Date: 10/02/2019
Date Signed: 10/04/2019 10:15:43 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:	RODRIGUEZ, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	376628433
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/02/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:09 AM
MET WITH:	Sandra Rodriguez, Applicant		TIME COMPLETED:	01:50 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	THIS IS AN ELECTRONIC COPY OF A HAND WRITTEN REPORT Licensing Program Analyst (LPA) Elizabeth Rivera conducted an announced pre-licensing inspection with applicant Sandra Rodriguez. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This 2 story home was toured and inspected to ensure environment is safe for the care and supervision of children. The home has a total of 4 bedrooms, 2 bath, kitchen, dining room, and garage. Applicant provided proof control of property for review by the Department. Applicant will use the following areas for child care: 2 rooms on first floor, the bathroom, back patio area that is properly fenced. Off limits area include: the garage, complete upstairs, and front yard. They are made inaccessible to day care children through use of door locks, door latches, and safety gates. Aplicant will utilize back back patio for outdoor activities, it is properly fenced. Home has barricated stairs with safety gates on top and bottom. There are no bodies of water present in the home. The fire extinguisher is rated 2A 10B:C, smoke and carbon monoxide detectors meet requirements and are operational. All poisons, cleaners, and hazardous items in the home are inaccessible to children through latches, locks, and/or placed up on high surfaces. Children's toys and play equipment are available. Applicant states there are NO firearms or other weapons in the home. Applicant has completed 8 hours of preventative health, Pediatric CPR and First Aid certifications expire on 08/2021. Required documents will be posted. Applicant and all adults residing in the home have been cleared for criminal record and child abuse index clearances. Applicant was advised that any new/additional adults must be cleared prior to working or residing in the home. Any minor upon his/her 18 birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewd and are in compliance for applicant. Applicant has completed Mandated Reporter Training AB1207. Per applicant operating hours are 6:30 a.m. - 5:30 p.m., Monday through Friday. Advised applicant that no changes should be made to the home without prior notice and/or approval from Licensing. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations/laws governing family child care homes.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elizabeth Rivera	TELEPHONE: (619) 767-2200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

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: RODRIGUEZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 376628433
	VISIT DATE: 10/02/2019

NARRATIVE

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Applicant does not plan on providing Incidental Medical Services (IMS) to clients. IMS policy was discuseed. 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 Deparment 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/childganda.htm The new provider Resource Packet was reviewed with the applicant including information on the following: SIDS, shaken baby, insurance, child abuse reporting, community resources, childrens records, facility records, required postings, immunizations, unusual incident report, roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items items are prohibited during day care operating hours (walker, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. The maximum capacity for a small child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more that 3 infants; or 8 children with no more than 2 infants, 1 child in kingergarden or elemantary school and 1 child at least age 6 including children under 10 who live in the licensee's home. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov. A regular Small Child Care Home license maybe issued upon final file review. The following correction is needed prior to the issuance of the regular license: LPM review and approval.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elizabeth Rivera	TELEPHONE: (619) 767-2200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

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