393616949-3-13-2023-53-CC-CBEY-CPVLL7-20230313085036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393616949
Report Date: 03/10/2023
Date Signed: 03/13/2023 08:52:40 AM

Document Has Been Signed on 03/13/2023 08:52 AM - 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	ALVARADO, JAZARY		FACILITY NUMBER:	393616949
ADMINISTRATOR:	ALVARADO, JAZARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 229-1446
CITY:	TRACY	STATE: CA	ZIP CODE:	95377
CAPACITY:	14	CENSUS: 6	DATE:	03/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jazary Alvarado		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Corina Beckby met with licensee, Jazary Alvarado for the purpose of an unannounced annual random inspection. Present in the home were licensee and her assistant supervising 6 children. Licensee's operating hours are 23 hours 7 days a week. LPA verified the annual fees are current.

Licensee's stated there are no new residents in the home which is a 2 story, 4 bedrooms, 2 1/2 bathrooms. All Adult residents have criminal record clearances. Licensee was reminded that all adults18 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.

A health and safety inspection was conducted in all areas of the home accessible to children in care. During inspection, licensee requested to make the bottom bedroom off limits. Off-limits areas include upstairs and bottom bedroom. Off limit areas are being made inaccessible by closed/locked doors, gates and/or supervision. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed the required postings, a working phone, SA40ABC fire extinguisher and was serviced August 17, 2022, and functioning smoke and carbon monoxide detectors. There are no bodies of water on the premises. LPA toured the kitchen area and verified knives were inaccessible to children and stored in a top cabinet in the kitchen. Licensee stated there are no weapons in the home. Toxic and hazardous items are inaccessible to children. The fireplace in the home is not used during operation hours. Personal medications are stored upstairs master bedroom closet with a lock and inaccessible to children.

Continued on LIC809C...

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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

FACILITY NAME: ALVARADO, JAZARY	FACILITY NUMBER: 393616949
	VISIT DATE: 03/10/2023

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LPA observed age-appropriate toys for children in the living room. Toys appear to be clean and safe. The outdoor play space is fenced. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

Five children’s files were reviewed. LPA observed immunization records, emergency information, and signed Family Child Care Home Notification of Parents' Rights in children's files. A current roster is being maintained and fire and disaster drills were conducted at least once every six months and documented. The licensee’s immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Letters of declination for the flu shot were observed for licensee and assistants. LPA observed current EMSA CPR and First Aid certification was verified and expires on 1/6/25 and AB 1207 Mandated Reporter Training was verified and expires on 7/11/24. Licensee understands Mandated Reporter Training must be completed every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be found at: mandatedreporterca.com.

In addition, LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. Licensee uses play yards for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping. LPA provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, during today's inspection and an example of a sleep log. 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. 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.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. 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.
Continued LIC809C...

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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

FACILITY NAME: ALVARADO, JAZARY	FACILITY NUMBER: 393616949
	VISIT DATE: 03/10/2023

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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.

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

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information

An exit interview was conducted, and report was reviewed with the licensee, Jazary Alvarado. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC809 (FAS) - (06/04)

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