393601416-11-20-2019-53-CC-CJAN-BJ4QNB-20191120111853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393601416
Report Date: 11/20/2019
Date Signed: 11/20/2019 11:18:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	SALAIZ, MICHELLE		FACILITY NUMBER:	393601416
ADMINISTRATOR:	SALAIZ, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 823-6844
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	14	CENSUS: 9	DATE:	11/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Michelle Salaiz		TIME COMPLETED:	11:30 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	Licensing Program Analyst (LPA) Christopher Jackson met with licensee Michelle Salaiz and Dennis Salaiz for an annual/random inspection. The census was nine children in attendance. LPA toured areas of the home accessible to the children. Off-limit areas: laundry room, garage, and shop in backyard. Licensee acknowledged that children may never enter these off-limit areas. Licensee stated there are no new residents in the home, and all adult residents have criminal record clearances. The facility's hours of operation are Monday through Friday from 5:00 am - 5:30 pm. LPA observed current CPR/First Aid certificates expires 09/09/21. LPA observed posted License, Parents' Rights Poster and Emergency Disaster Plan. LPA reviewed three children's records and client roster during today's inspection. LPA observed hazardous items properly stored out of children's reach. Fire extinguisher, carbon monoxide and smoke detector meet regulation. LPA observed the swimming pool in the back yard is fenced per Title 22 Regulations with a self-closing and self-latching gate. LPA observed fire drills are conducted and documented at least once every six months. Toys appear to be safe and in working order. LPA provided the Licensing Agency website (www.ccld.ca.gov), so the licensee may obtain updated licensing information, regulations, and forms. LPA discussed AB 1207 Mandated reporter training with licensee and reminded licensee of the requirement to update the training every two years. LPA has provided website for free online training mandatedreporterca.com Report continues 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: SALAIZ, MICHELLE	FACILITY NUMBER: 393601416
	VISIT DATE: 11/20/2019

NARRATIVE

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LPA discussed recent changes in licensing requirements, including SB 277 (no longer accepting religious beliefs for immunization's) and SB 792 pertaining to immunization requirements for children and staff - Licensee provided proof of immunization's during today’s inspection.

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. This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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: www.ada.gov/childqanda.htm

No title 22 deficiencies were cited on today’s inspection. Report was reviewed with licensee, exit interview conducted. Notice of Site Visit was posted.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC809 (FAS) - (06/04)

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