393614011-10-21-2019-53-CC-CJAN-BH6UGE-20191021153412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393614011
Report Date: 10/21/2019
Date Signed: 10/21/2019 03:34:21 PM

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:	PEREZ, ERICA		FACILITY NUMBER:	393614011
ADMINISTRATOR:	PEREZ, ERICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 824-7538
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	14	CENSUS: 8	DATE:	10/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Erica Perez		TIME COMPLETED:	03:40 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 Analysts (LPA) Christopher Jackson met with licensee Erica Perez for an annual/random inspection. The census was eight children in attendance during today's inspection. Also present was licensees mother. The program operates on the second floor of the home in the mother-in-law unit located off the master bedroom. LPA toured areas of the two story home accessible to the children in care. Off-limit areas are: laundry room and garage. 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 7:30 am - 5:00 pm. There is an in ground pool on the property in the back yard. It is surrounded by a 5-ft. high mesh fence that surrounds the pool area. The fence ensures there are no openings or windows that directly access the pool area. During today's inspection LPA tested the pool fence and observed the gate to self-close and self-latch. During today's inspection LPA did not bserve a CPR/First Aid certificate, LPA observed that it had expired on 06/27/19. LPA observed posted License, Parents' Rights Poster and Emergency Disaster Plan. LPA observed hazardous items properly stored out of children's reach. Fire extinguisher, carbon monoxide and smoke detector meet regulation. LPA observed fire drills are conducted and documented at least once every six months. Toys appear to be safe and in working order. LPA discussed with licensee about the following 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 during today's inspection. Report Continues on 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

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: PEREZ, ERICA	FACILITY NUMBER: 393614011
	VISIT DATE: 10/21/2019

NARRATIVE

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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 for licensee, mandatedreporterca.com.

LPA provided the Licensing Agency website (www.ccld.ca.gov), so the licensee may obtain updated licensing information, regulations, and forms.

LPA reviewed three files for children in care during today's inspection. LPA observed the proper documentation in the children's files reviewed. During today's inspection LPA discussed and provided a pamphlet with proposed changes to sleep regulations. LPA discussed and provided a pamphlet for lead exposure in water. LPA advised licensee to provide parents with copies of the lead exposure flyer and document that each parent enrolled received a copy of the handout.

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

During today's inspection licensee requested to add additional rooms to the off limits areas. Licensee requested to add the two upstairs bedrooms at the top of the stairs and the upstairs restroom also at the top of the stairs to the off limit areas. Licensee also requested to add the master bedroom bathroom to the off limit areas. LPA observed the areas and will grant the request of adding the rooms to the off limit areas.

During today's inspection title 22 deficiencies were observed cited on the 809-D page. This 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: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PEREZ, ERICA	FACILITY NUMBER: 393614011
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/21/2019 Section Cited	1 2 3 4 5 6 7	Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR shall be onsite at all times when children are present at the facility, and shall be present with the children when children are off site from the
	8 9 10 11 12 13 14	facility for facility activities. In the event of an emergency, additional staff members, who are on site when children are present at the facility, to have a current course completion card in pediatric first aid and pediatric CPR. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	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: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

LIC809 (FAS) - (06/04)

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