393620128-11-26-2019-53-CC-SWIS-BJAURG-20191126144842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393620128
Report Date: 11/26/2019
Date Signed: 11/26/2019 02:48:47 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:	NEGRON, ASHLEY M		FACILITY NUMBER:	393620128
ADMINISTRATOR:	NEGRON, ASHLEY M		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 221-0005
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	14	CENSUS: 6	DATE:	11/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Ashley Negron		TIME COMPLETED:	02:39 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) Stacey Williams met with licensee, Ashley Negron for an unannounced random annual inspection. There were six children present during today’s inspection. Criminal record clearances were verified for residents living in the home and licensee’s assistant. LPA toured areas of the home accessible to children in care. Off-limit areas include: master bedroom and the garage. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced. Licensee acknowledges that children may never be left unsupervised in an unfenced area of the front yard. There are no bodies of water on the property. LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expires January 2021. LPA reviewed children, licensee and licensee’s assistant’s file. Immunization records were reviewed. Required licensing postings were viewed on a bulletin board in the entry of the home. Hazardous items and cleaning compounds were inaccessible to children. Medications are inaccessible to children. Fire extinguisher and smoke detector meet regulation. Carbon monoxide detector was operable. 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. 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: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: NEGRON, ASHLEY M	FACILITY NUMBER: 393620128
	VISIT DATE: 11/26/2019

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
26
27
28
29
30
31
32

LPA discussed the Mandated Reporter Training with licensee. Mandated reporter training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM . Mandated reporter certificates were viewed in licensee and her assistant’s file.

There were no Title 22 deficiencies observed in the areas evaluated during today’s inspection.

This facility evaluation report was reviewed and discussed with the licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The implementation of AB 2370, lead exposure in Family Child Care Homes and proposed safe sleep regulations was discussed. A copy of this report will remain on file for a period of 3 years for public review upon request. A notice of site visit was provided and should remain posted for 30 days for parental review. Appeal rights were discussed and provided to licensee.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2