393608056-6-5-2019-53-CC-MPOE-BCUPVF-20190605113903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393608056
Report Date: 06/05/2019
Date Signed: 06/05/2019 11:39:15 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:	ROSAS, MARIA		FACILITY NUMBER:	393608056
ADMINISTRATOR:	ROSAS, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 835-8315
CITY:	TRACY	STATE: CA	ZIP CODE:	95377
CAPACITY:	14	CENSUS: 9	DATE:	06/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maria Rosas		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Mary Ponce met with licensee Maria Rosas for an unannounced annual inspection. The facility operations Mon-Fri 6:00AM-6:00PM. LPA toured all areas of the home that are accessible to the children and observed care and supervision, a current roster of children, capacity and ratio were observed. Present in the home was the licensee, licensee's husband, and licensee's sons and 9 children in care. LPA confirmed that all adults residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan. Off-limit areas include: Laundry Room, Garage and bedroom next to the laundry room. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There are no bodies of water on the property and licensee stated there are no weapons in the home. LPA observed current CPR and First Aid certificates that expires on 1/2021. LPA observed that poisons are locked, smoke detector meets regulation; however, during the inspection, LPA observed the Carbon Monoxide Detector did not have batteries which is an immediate risk to the health and safety of the children. Licensee's husband immediately replaced batteries and stated he will be purchasing a new Carbon Monoxide Detector. Fire extinguisher is fully charged. There is no fire place in the home. Cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary Ponce	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019

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: ROSAS, MARIA	FACILITY NUMBER: 393608056
	VISIT DATE: 06/05/2019

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 26 27 28 29 30 31 32	parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided). Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary Ponce	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: ROSAS, MARIA	FACILITY NUMBER: 393608056
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/05/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/06/2019 Section Cited HSC 1597.543	1 2 3 4 5 6 7	Carbon monoxide detectors required; inspection. Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards	1 2 3 4 5 6 7	POC: Licensee stated that she will purchase a new Carbon Monoxide Detector and install it. Licensee will provide proof of purchase and installation to LPA by POC due date.
	8 9 10 11 12 13 14	established in Chapter 8......... This regulation was not met as evidence of. LPA observing no batteries in the Carbon Monoxide Detector during inspection.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary Ponce	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ROSAS, MARIA	FACILITY NUMBER: 393608056
	VISIT DATE: 06/05/2019

NARRATIVE

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LPA Ponce provided the Safe Sleep Practices brochure along with the Lead-water testing brochure.

LPA discussed the new Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. LPA advised licensee to ensure that all adults providing direct supervision of children have their Mandated Reporter Training.

Licensee, and those working in the home have proof of immunization for Measles and Pertussis.

Licensee does not provide Incidental Medical Services at this time. LPA Ponce advised licensee that if she enrolls any children that require Incidental Medical Services, to inform licensing so that an Incidental Medical Service Plan can be created.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPAs also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Title 22 deficiency is cited on the subsequent pages of this report.
Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary Ponce	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019

LIC809 (FAS) - (06/04)

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