376629022-4-26-2021-20-CC-JARL-C2FP74-20210426110320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629022
Report Date: 04/26/2021
Date Signed: 04/26/2021 11:03:35 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:	ROCHA, CARMEN FAMILY CHILD CARE		FACILITY NUMBER:	376629022
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	04/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Carmen Rocha		TIME COMPLETED:	11:00 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 April 26^th, 2021, at 9:45 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a capacity increase inspection with Licensee Carmen Rocha. Due to the COVID 19 outbreak, this inspection was done as a tele visit via the FaceTime platform. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was the Licensee, her spouse, one (1) daycare infant and two (2) daycare toddlers. The Licensee has more than one (1) year of experience as a regulated small family child care home operator. On 03/29/2021, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 04/07/2021 for fourteen (14) children. This one story three bedroom and two bath home was toured and inspected. The hours of operation are Monday through Friday, from 5:00 AM to 11:00 PM and Saturday & Sunday from 7:00 AM to 11:00 PM. The following areas are used for childcare: the kitchen, living room, dining room, bedroom #1, hallway bathroom, front yard and part of the backyard. The off-limit areas are bedroom #2, master bedroom with the attached bathroom and the garage. The side of the yard is also off limits. Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Landlord consent is on file. Background criminal record clearances were verified and discussed. The facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and the first aid kit in place. Pediatric 1st Aide and CPR expire on 10/26/2021. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility. The Licensee was provided with the Ratio/Capacity Worksheet for a large family child care home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

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: ROCHA, CARMEN FAMILY CHILD CARE	FACILITY NUMBER: 376629022
	VISIT DATE: 04/26/2021

NARRATIVE

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Licensees of family day care homes shall ensure that at least one staff member shall always be onsite when children are present at the facility and shall be present with the children when children are offsite from the facility for facility activities.

The Licensee shall ensure at least one staff member has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority.

Prior to employment or initial presence in the childcare home, all employees subject to a criminal record review shall: obtain a California clearance or a criminal record exemption as
required by law or Department regulations or request a transfer of a criminal record clearance.

The Licensee shall not employ a staff member if they have not been immunized against influenza, pertussis, and measles. Each employee shall receive an influenza vaccination between August 1 and December 1 of each year. The employee may submit a yearly written declaration attesting that they have declined the influenza vaccination. This exemption applies only to the influenza vaccine. Documentation of immunizations are to be maintained in the staff’s facility personnel record.

The Licensee shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052 (4/88)) form furnished by the Department. Each employee shall be requested to sign and date the notice form acknowledging receipt. A copy of the signed notice form shall be retained in the employee's personnel record. If the employee refuses to sign the notice form, a dated notation to that effect shall be retained in the employee's personnel record.

The Licensee agrees to comply with all regulations and laws governing family childcare homes. The Licensee 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 (SCCCA) information was provided. The Licensee is already registered on the SCCA email notification list. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

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: ROCHA, CARMEN FAMILY CHILD CARE	FACILITY NUMBER: 376629022
	VISIT DATE: 04/26/2021

NARRATIVE

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In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved as of 04/26/2021. A new license will be generated and mailed to the provider.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. LPA will electronically provide this document to the Licensee. An exit interview was conducted. A copy of this report and Licensee/Appeal Rights (LIC 9058) will be e-mailed to the Licensee. The Licensee was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

LIC809 (FAS) - (06/04)

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