376628971-10-5-2020-20-CC-DSTS-BU4TF7-20201005144104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628971
Report Date: 10/05/2020
Date Signed: 10/05/2020 02:42:37 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:	DORVILUS, ROSE ERTHA FAMILY CHILD CARE		FACILITY NUMBER:	376628971
ADMINISTRATOR:	ROSE ERTHA DORVILUS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 394-9731
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	14	CENSUS: 0	DATE:	10/05/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Rose Ertha Dorvilus		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	Licensing Program Analyst (LPA) Dana Stevens conducted an announced pre-licensing tele-inspection for the purpose of a change of location with applicant, Rose Ertha Dorvilus.The visit was conducted via the ZOOM application per CDPH recommendations due to the COVID19 pandemic. 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 two story, six bedroom, three and 1/2 bath home was toured and inspected. Applicant will use the following areas for child care: living room, downstairs bathrooms (one full, one half), kitchen, and one bedroom. Off limits areas downstairs include: one bedroom, the laundry room, the converted garage, the enclosed patio and the backyard. The entire upstairs (4 bedrooms, 2 bath) is off-limits and is made inaccessible to day care children through the use of a safety gate at the bottom of the stairs.The fire extinguisher is rated 3A 40B:C and is located in the kitchen.Smoke and carbon monoxide detectors are located in the living room and are operational. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas or secured out of reach of children. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone. Applicant will utilize the side patio for outdoor activities, it is properly fenced. Applicant indicated there are no firearms or other weapons in the home.The home has an in-ground pool in the backyard that is not properly fenced. Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed Mandated Reporter AB1207 training. Applicant has completed the 8 hours of Preventative Health practices and has obtained Lead Poisoning Prevention certification. Pediatric CPR and First Aid certifications expire on 09/2021. Required documents are posted.Applicant and adult residents in the home have criminal record clearances and/or exemptions on file.Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Immunization records per SB792 were reviewed and are in compliance. LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DORVILUS, ROSE ERTHA FAMILY CHILD CARE	FACILITY NUMBER: 376628971
	VISIT DATE: 10/05/2020

NARRATIVE

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Applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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

The New Provider Resource Packet was reviewed with the applicant including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.

LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The following corrections are needed prior to the issuance of the license:

In-ground pool needs to made inaccessible by a pool cover or surrounding the pool with a fence that meets Title 22 regulations for Family Child Care Homes.

A Regular Small Family Child Care Home license maybe issued after proof of correction and upon final file review. An exit interview was conducted and a copy of the report and appeal rights (LIC 9058) were provided by email to the applicant. Applicant understands that an email acknowledgment of receipt of report and appeal rights must be received within 24 hours.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2020

LIC809 (FAS) - (06/04)

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