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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622590
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:22:28 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:GODINEZ, ERICAFACILITY NUMBER:
393622590
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
09/22/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Erika GodinezTIME COMPLETED:
03:35 PM
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On Wednesday September 22, 2021, at 01:35 pm. Licensing Program Analyst (LPA) Elvira Sierra met with Licensee Erika Godinez for an annual random and an increase of capacity inspection. Facility hours of operation are M-F from 08:00 a.m to 05:30 p.m. Upon arrival there were 3 napping children being supervised by the Licensee. One more child arrived later during the inspection. Facility was granted fire clearance approval by Stockton Fire Department on 09/08/21 for a capacity of 14 children.

At 01:45 a.m. a health and safety inspection was conducted and the following was observed. The Off-limits areas include; Entire home except Living Room # 2,Dining Room # 2, bathroom # 1 and backyard. License acknowledged that children may never enter these off-limit areas. The home is equipped with at least one working smoke/carbon monoxide detector and a fully charged fire extinguisher that meets regulations. Stairs leading to the second floor are properly barricaded. Sharp utensils and knives are inaccessible to children. Homes has sufficient age appropriate toys, reading material and napping equipment for the children in care. Outdoor area is free of any debris or sharp objects. Licensee provide meals. Per Licensee there are no weapons or bodies of water on the premises. Licensee was advised that prior to taking alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed changes.

3 children records were reviewed and are complete. Licensee has a current CPR that expires on 08/27/2022. Mandated Reporter Training expires on 06/24/2022. Licensee understands training must be updated every 2 years. LPA advised that baby walkers, bouncers, jumpers, and similar items are not allowed in a Family Child Care Home.



Report continues subsequent page 809C---
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: GODINEZ, ERICA
FACILITY NUMBER: 393622590
VISIT DATE: 09/22/2021
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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.


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.

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.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with Licensee.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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