393615613-1-5-2022-53-CC-CJAN-CADRJ9-20220105120335

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393615613
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:03:43 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:	AYALA, MARY		FACILITY NUMBER:	393615613
ADMINISTRATOR:	AYALA, MARY AND JOEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 329-3800
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	14	CENSUS: 4	DATE:	01/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Mary Ayala		TIME COMPLETED:	12:10 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) Christopher Jackson met with licensee Mary Ayala for an unannounced random annual inspection and toured all areas of the home accessible to children in care. Off-limit areas include: entire upstairs, laundry room and storage room. Licensee acknowledged that children may never enter these off-limit areas. The census included four children in care age, three, five, six and seven. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. LPA discussed that all adults 18 and over living or working in the home, 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. LPA observed current CPR/First Aid certificates which expire on 06/23. LPA discussed licensing requirements, including the posting of licensing inspection notices, reports and Parent Notification Requirements. LPA reviewed four children’s files in care. LPA observed fire drills were conducted at least once every six months and documented. Report Continues on 809-C

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) 926-0269
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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

FACILITY NAME: AYALA, MARY	FACILITY NUMBER: 393615613
	VISIT DATE: 01/05/2022

NARRATIVE

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LPA observed hazardous items inaccessible to children. LPA observed cleaning materials to be inaccessible to children in care. LPA observed 3 A 40 BC fire extinguisher, smoke detector and carbon monoxide detector meet regulation. The backyard is fenced and gated. There are no bodies of water observed.

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

LPA discussed 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 staff immunization's. LPA's discussed COVID-19 practices during today's inspection.

LPA discussed the 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.

Report Continues on 809-C

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) 926-0269
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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: AYALA, MARY	FACILITY NUMBER: 393615613
	VISIT DATE: 01/05/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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. LPs also informed licensee 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.

LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) 926-0269
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC809 (FAS) - (06/04)

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