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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616039
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:34:34 PM


Document Has Been Signed on 08/08/2023 02:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MAYO, TARAFACILITY NUMBER:
393616039
ADMINISTRATOR:MAYO, TARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 570-3382
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 0DATE:
08/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tara MayaTIME COMPLETED:
02:45 PM
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On 08/08/23, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Tara Maya for the purpose of an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. Home is three bedrooms and two bathrooms house. Licensee stated there are no new residents in the home since licensure. Per Licensee hours of operation are M-F from 07:00am to 05:00pm. There were no daycare children present during the inspection.

A health and safety inspection was conducted in all areas accessible to children. Off-limit areas include: All bedrooms, and Garage. Licensee was reminded that day care children may never enter these off-limit areas. Home is clean and appropriately ventilated. Age-appropriate toys and reading material were observed. Medications, knives and hazardous items were observed inaccessible to children. There is a weapon in the home that is storage according to Tile 22 regulations. Home has a in ground swimming pool that is surrounded by a mesh fence with reinforced poles that meets regulations. Facility maintains a working phone, a functioning carbon/monoxide detector and a 2A10BC fire extinguisher that meets Fire Marshall standards. LPA reminded Licensee that any changes to the home or any new construction must be reported to Licensing. Outdoor play area is fence for supervision. Licensee was advised that play equipment must be in good repair at all times. Licensee last emergency drill was conducted on 04/01/23 and was properly logged. First Aid Kit is fully stocked and accessible. Licensee stated she provide meals and transportation if needed. Facility roster was reviewed and is complete and up to date. CPR/First Aid certification was reviewed. Expiration date is 01/25. Mandated Reported Training was observed and expired on 12/20/24.
Licensee 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. ---------------------Report continues on subsequent page 809C--
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MAYO, TARA
FACILITY NUMBER: 393616039
VISIT DATE: 08/08/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers
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-andresources/safe-sleep as an additional resource. LPA 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Tara Mayo.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2