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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629368
Report Date: 05/13/2022
Date Signed: 05/16/2022 07:12:39 AM


Document Has Been Signed on 05/16/2022 07:12 AM - 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:RIVERA, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376629368
ADMINISTRATOR:TERESA RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 864-3312
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:14CENSUS: DATE:
05/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:Teresa RiveraTIME COMPLETED:
05:45 PM
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On 05/13/2022 at 4:40 AM, Licensing Program Analyst (LPA) Adrian Castellon conducted an announced change of location inspection with licensee Teresa Rivera. The 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 single story 4-bedroom, 3-bathroom home was toured and inspected to ensure the environment is safe for the care and supervision of children.

Licensee has provided proof of control of property for review by the Department. The licensee will use the following areas for child care: entire first floor. Off-limits areas include: second floor which has been properly barricaded. Inaccessible areas are made inaccessible to daycare children through the use of door locks, safety latches, gates, and fencing. 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. The SDCCRO has received a fire clearance report from the city of Chula Vista Fire Department allowing for up to 14 children.

Children’s toys and play equipment are available. Applicant states there are NO firearms or other weapons in the home. Pediatric CPR and First Aid certifications have expired. Licensee has a renweal appointment on 5/15/22. Applicant and all adults in the home have been cleared for criminal record and child abuse index clearances. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Any minor upon his/her 18th birthday must be fingerprinted within 30 days. See continuation form 809C
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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: RIVERA, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376629368
VISIT DATE: 05/13/2022
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Incidental Medical Services (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
 
LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


 
Exit interview conducted and report was reviewed with the applicant Heidi Martin.  A Regular Small Family Child Care Home license may be issued upon final file review.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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