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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621695
Report Date: 06/27/2024
Date Signed: 06/27/2024 11:55:27 AM


Document Has Been Signed on 06/27/2024 11:55 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CRUZ, CARMENFACILITY NUMBER:
393621695
ADMINISTRATOR:CRUZ, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 561-5120
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:14CENSUS: 4DATE:
06/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Carmen CruzTIME COMPLETED:
12:20 PM
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On 06/27/24, Licensing Program Analyst (LPA) Elvira Sierra met with the Licensee, Carmen Cruz for the purpose of an unannounced annual inspection. Licensee requested to change the hours of operation to seven days a week from 05:00 a.m to 10:00 p.m. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing Office. The licensee stated that no new residents moved into the home since licensure. Entrance Checklist for Family Child Care Homes was provided to Licensee. Present in the facility was Licensee and Licensee's mother caring for four children. Capacity specified on the license was met on today’s inspection.

A health and safety inspection were conducted in all areas accessible to children. Off limit areas are; Bedrooms # 1(master bedroom) including bathroom inside the master bedroom, bedroom # 3, Kitchen, laundry area, garage, and locked backyard shed. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Home is clean and appropriately ventilated. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector. Toys and reading material were observed available for the daycare children. There is a weapon in the home that is stored according to Title 22 regulations. No bodies of water were observed on the premises. Toxic and hazardous items are inaccessible to children. Outdoor area is fenced for supervision and was observed free of any hazards. Licensee provides meals to the children. Licensee stated he transport children if needed.

LPA reviewed four children and one personnel’s records. LPA observed all required forms for the children in care are complete and maintained in the file. Current in person EMSA CPR and First Aid certification was verified for Licensee and Licensee assistant and expires on 10/14/24 and AB 1207 Mandated Reporter Training was verified (expires 04/10/25). LPA observed a current roster and fire drills are conducted at least once every six months and are properly log.
Report continues 809-C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CRUZ, CARMEN
FACILITY NUMBER: 393621695
VISIT DATE: 06/27/2024
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 The license explained that absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee must notify the department anytime facility is closing for vacation or any other leave that requires to be absence more than 20 percent per day.

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 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.

Licenses acknowledge that a Plan for Providing IMS must be submitted to the Department if provided. 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. 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 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.

Licensee was made aware of the (LIC9227) Individual Infant Sleeping Plan, for infants under 12 months and sleep logs for all infants in care under 24 months need to be maintained in children’s files. LPA discussed and provided an example of a sleep log.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Report continues subsequent 809C...

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

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CRUZ, CARMEN
FACILITY NUMBER: 393621695
VISIT DATE: 06/27/2024
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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.

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

During the exit interview, the LICENSEE, Carmen Cruz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.


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

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

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
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