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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500201
Report Date: 08/12/2021
Date Signed: 08/12/2021 02:58:59 PM

Document Has Been Signed on 08/12/2021 02:58 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:GARCIA, MAYRA VERENICEFACILITY NUMBER:
394500201
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mayra Verenice GarciaTIME COMPLETED:
03:15 PM
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Mayra Garcia is Spanish speaking and Licensing Program Analyst (LPA) Marissa Soto spoke with Mayra Garcia in Spanish, and have translated the conversation to English below.

On Thursday, August 12, 2021 at approximately 01:30 PM Licensing Program Analyst (LPA) Marissa Soto conducted a on-site inspection for the purpose of an unannounced increase of capacity inspection. Licensee Mayr had recently submitted an application for an increase in capacity from 8 to 14 children. Licensee operates Monday- Friday 5am to 5pm. Present during the inspection was Licensee supervising 5 children.

A health and safety inspection was conducted inside and out. This facility is a one single story home which consists of 3 bedrooms, 2 bathrooms, living room, kitchen, backyard, front yard, driveway and garage. The off-limit areas in the home will consist of: laundry room. Licensee requested that her master bedroom and backyard be made off-limits. Fire extinguisher, smoke and carbon monoxide detectors meet regulation. Sharp knives are stored in a kitchen in a locked drawer. Toxins and cleaning supplies are inaccessible to the children. Toys appear to be safe and appropriate for children in care. Licensee stated that there are no weapons in the home and no bodies of water. The facility currently does not provide Incidental Medical Services – IMS. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family childcare home evaluator manual (FCCH EM) Policy 102417.

Adult residents have criminal record clearance. No additional adults have moved into the home since licensure. A current CPR/First Aid was verified and expired on 10/21. LPA reviewed large family childcare home capacity limitations with licensees. LPA discussed SB 277 and SB 792 pertaining to immunization requirement for children and staff and advised Licensee to visit the licensing website at www.ccld.ca.gov for current forms, laws, regulations and legislation.



Report continued subsequent page 809C----
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2021
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: GARCIA, MAYRA VERENICE
FACILITY NUMBER: 394500201
VISIT DATE: 08/12/2021
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Fire Safety Inspection was granted on 07/29/21 by Lathrop-Manteca FPD, and home has been cleared for up to 14 children.

Safe Sleep in child care, the effects of lead exposure brochures, COVID-19 posting documents and the use of Personal Protective Equipment during COVID-19 outbreak guidance were discussed and observed in the home.

As of today's date 08/12/21, this facility is approved for a large license, to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or elementary school and 1 child at least age 6 years old with a maximum of 3 infants.

Exit interview and appeal rights were discussed. A copy of this report, appeal rights and notice of Site Visit were provided to Licensee. Licensee understands the Notice of Site Visit must remain hung and visible to parents for 30 days.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC809 (FAS) - (06/04)
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