376629267-2-17-2022-20-CC-DSTS-CBR2KU-20220217162832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629267
Report Date: 02/17/2022
Date Signed: 02/17/2022 04:28:38 PM

Document Has Been Signed on 02/17/2022 04:28 PM - It Cannot Be Edited

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:	PERAZA, BRENDA FAMILY CHILD CARE		FACILITY NUMBER:	376629267
ADMINISTRATOR:	BRENDA PERAZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 777-9111
CITY:	SAN YSIDRO	STATE: CA	ZIP CODE:	92173
CAPACITY:	14	CENSUS: 0	DATE:	02/17/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Brenda Peraza		TIME COMPLETED:	04:30 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	On 02/17/2022 at 3:30 PM, Licensing Program Analyst (LPA) Dana Stevens conducted an announced pre-licensing inspection with applicant, Brenda Peraza. 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, 4 bedroom, three bath home was toured and inspected. Applicant will use the following areas for child care: living room, daycare room, downstairs bathroom, and kitchen. Off limits areas include: Entire upstairs, laundry and garage. These areas are made inaccessible to children through the use of doorknob covers, and a safety gate. Applicant will utilize the backyard for outdoor activities, it is properly fenced. The upstairs is not used and is gated off at the bottom of the stairway and the applicant understands the gate must be in place when children under five years are present during day care hours. The fireplace is screened.The fire extinguisher is rated 2A 10B:C and is located in the kitchen, combination smoke/ carbon monoxide detector meets requirements and is operational. Fire Clearance was granted for 14 children on 02/07/2022. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas with cupboard latches and door locks and secured out of reach of children. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone. Applicant maintains documentation of proof of control of property for review by the Department. Applicant completed Mandated Reporter AB1207 training in November 2021. Assistant completed Mandated Reporter in December 2021. Applicant has completed the 8 hours of preventative health. Pediatric CPR and First Aid certifications expire in 06/2022. Required documents are posted. Applicant and adult residents in the home have criminal record clearances and/or exemptions on file.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

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: PERAZA, BRENDA FAMILY CHILD CARE	FACILITY NUMBER: 376629267
	VISIT DATE: 02/17/2022

NARRATIVE

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Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. 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 they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. The hours of operation are 24 hours a day/7 days a week.

Applicant does not provide 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

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.

A Large Family Child Care Home license maybe issued upon final file review. An exit interview was conducted and a copy of the report was provided to the applicant.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC809 (FAS) - (06/04)

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