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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617392
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:03:17 PM


Document Has Been Signed on 03/03/2023 12:03 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:PLASENCIA, ROSALINDAFACILITY NUMBER:
393617392
ADMINISTRATOR:PLASENCIA, ROSALINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 325-4225
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:14CENSUS: 2DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Rosalinda Plasencia TIME COMPLETED:
12:00 PM
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On March 3, 2023, at approximately 9:30AM, Licensing Program Analyst (LPA) Stacey Williams conducted an unannounced 1 Year required inspection and met with Licensee, Rosalinda Plasencia. LPA observed two children supervised by Licensee. Criminal record clearances have been verified. Facility fees were reviewed. Licensee stated there are no new residents in the home since licensure. Licensee operation hours are Monday- Friday: 5:30 AM- 6:00 PM and does not provide overnight care.

LPA and Licensee toured the facility during the inspection. Off limit areas are the entire upstairs and the garage. The backyard is fenced and Licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There are no bodies of water on the property. Licensee stated that there are no weapons in the home.

LPA conducted record reviews during the inspection. Child files and Licensee’s file was reviewed. LPA discussed mandated reporter training with the Licensee. Licensee understands Mandated Reporter Training is to be completed every two years. Mandated reporter training can be accessed at www.mandatedreporterca.com. CPR/First Aid certification was reviewed. Expiration date is 2/2024. LPA observed fire drills were conducted at least once every six months and documented.

LPA observed that there were no hazardous items accessible to children. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe.

Licensee was reminded 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 of the 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.

REPORT CONTINUED ON SUBSEQUENT PAGE, 809 C

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: PLASENCIA, ROSALINDA
FACILITY NUMBER: 393617392
VISIT DATE: 03/03/2023
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This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA Information 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 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.


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/process.

No Title 22 Deficiencies observed in the areas that were evaluated.

LPA reviewed report with the Licensee, Rosalinda Plasencia and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
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