376628994-10-12-2020-20-CC-MMAE-BUBMMS-20201012094425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628994
Report Date: 10/12/2020
Date Signed: 10/12/2020 09:45:43 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:	DIAZ, KARLA FAMILY CHILD CARE		FACILITY NUMBER:	376628994
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/12/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Karla Diaz		TIME COMPLETED:	10:00 AM

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	On October 12, 2020, at 9:00am, Licensing Program Analyst (LPA) Martha Malane conducted an announced pre-licensing inspection for the purpose of a Change of Location with applicant, Karla Diaz, via video conference (FaceTime), due to the COVID-19 outbreak. Purpose of the inspection is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This single-story, four bedroom, two bathroom home was toured and inspected. Applicant will use the following areas for child care: bathroom #1, living room, bedroom #1, kitchen and dining room. Off limits areas include: bedrooms #2, #3 and #4, bathroom #2 and the garage and are made inaccessible to day care children through the use of door knob covers and safety gates. Applicant will utilize the backyard for outdoor activities, it is properly fenced and supervision was discussed. Applicant states there are no bodies of water. The fire extinguisher is rated 3A10 B:C and is located in the kitchen, smoke and carbon monoxide detectors meet requirements and are operational. All poisons, detergents, cleaning compounds and medicines are inaccessible, secured and out of reach of children. Children’s toys and play equipment are available. The applicant has a working cell phone. Applicant indicated there are no firearms or other weapons in the home. Applicant maintains documentation of proof of control of property for review by the Department. Mandated Reporter AB1207 training was completed 7/13/20. Applicant completed the 8 hours of preventative health 11/ 2016. Pediatric CPR and First Aid certifications expire 11/3/20. Applicant has a criminal record clearance 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. Applicant states she is financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family child care homes. Hours of operation are Monday thru Sunday 5:00am - 12:00am. Continued on 809C…

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020

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: DIAZ, KARLA FAMILY CHILD CARE	FACILITY NUMBER: 376628994
	VISIT DATE: 10/12/2020

NARRATIVE

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Applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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. Megan’s Law was discussed meganslaw.ca.gov.

Provider Resources were reviewed with applicant including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby and prohibited items including no smoking or Corporal punishment in a day care.

LPA discussed the maximum capacity for a small family child care home: four infants only (infant means any child 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 Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

A Provisional Regular Small Family Child Care Home license is effective today, 10/12/2020, and will expire 1/12/2021 pending Lead Prevention Training Certification. A license will mailed to the facility.

LPA Malane explained the inspection report and applicant stated she understood. An exit interview was conducted and a copy of the report will be e-mailed to the applicant. Applicant was advised that acknowledgement of receipt of the report is to be received within twenty-four hours.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020

LIC809 (FAS) - (06/04)

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