393617392-2-27-2020-53-CC-SWIS-BM7SV7-20200227131216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393617392
Report Date: 02/27/2020
Date Signed: 02/27/2020 01:12:21 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:	PLASENCIA, ROSALINDA		FACILITY NUMBER:	393617392
ADMINISTRATOR:	PLASENCIA, ROSALINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 325-4225
CITY:	MOUNTAIN HOUSE	STATE: CA	ZIP CODE:	95391
CAPACITY:	14	CENSUS: 8	DATE:	02/27/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Rosalinda Plasencia		TIME COMPLETED:	01:20 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	On February 27, 2020 Licensing Program Analyst (LPA) Stacey Williams arrived at the home of Licensee, Rosalinda Plasencia at 10:44 AM. LPA met with Licensee, Rosalinda Plasencia. LPA observed (8) eight children supervised by Licensee. LPA toured areas of the home assessable to children with the Licensee. Off-limit areas include entire upstairs of the home and the garage. LPA made observations at 10:50 AM of children in the childcare room. Required licensing postings were viewed on a bulletin board at the entry of the home Children were engaged in various activities including circle time where children rehearsed numbers, alphabets, and the theme of the week. Licensee was observed interacting with preschool children and caring for an infant child. At 11:45 AM, Licensee was observed instructing children as they transitioned from the play area to their mealtime. LPA observed Licensee prepare and oversee lunch mealtime during today’s inspection. Children sanitized their hands prior to eating. Lunch was served in the kitchen dining area of the home. LPA toured the downstairs area of the home with Licensee. Hazardous items and cleaning supplies and medications are inaccessible to children. Fire extinguisher and smoke detector meet regulation. Carbon monoxide detector was operable. Licensee and LPA toured the backyard at 12:15 PM. The backyard is fenced. Report continues the following page, LIC 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: PLASENCIA, ROSALINDA	FACILITY NUMBER: 393617392
	VISIT DATE: 02/27/2020

NARRATIVE

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LPA conducted a records review at 12:30 PM. LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expires in June 2020 for Licensee and her Assistants.

LPA reviewed children and Licensee’s file. Child files included information pertaining to their authorized representative, consent for medical treatment and a medical assessment form. Immunization records were reviewed children, Licensee and her Assistant’s file.

Criminal record clearances were verified for Licensee and individuals associated to the facility.

LPA discussed the Mandated Reporter Training with licensee. Mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM .

Incidental Medical Services (IMS) policy was discussed. 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. 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 the implementation of AB 2370, lead exposure with Licensee. Licensee was encouraged to visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

An exit interview was conducted, and the licensing report was reviewed with Licensee, Rosalinda Plasencia. A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided to post during today’s inspection.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

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