394500249-6-30-2021-53-CC-CJAN-C4GQ8A-20210630115625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500249
Report Date: 06/30/2021
Date Signed: 06/30/2021 11:56:30 AM

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:	ESQUIVEL, MARIA OLIVIA		FACILITY NUMBER:	394500249
ADMINISTRATOR:	ESQUIVEL, MARIA OLIVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 712-9167
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	14	CENSUS: 6	DATE:	06/30/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Esquivel		TIME COMPLETED:	12:15 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) Christopher Jackson met with licensee Maria Esquivel for an unannounced random annual inspection and toured areas of the single story home accessible to children in care. Off-limit areas include Bedroom #1, Master Bedroom, side yard, and garage. The census included six children in care ages 2, 2.5, 2.5, 4, 7, and 9. Also present was licensee’s adult son during today's inspection. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. LPA observed current CPR/First Aid certificates which expire on 5/22. LPA discussed licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed two children’s files during today's inspection. LPA observed the files to be kept according to Title 22 regulations. LPA discussed the requirement for fire drills. LPA reminded licensee fire drills should be conducted at least once every six months and documented. LPA observed Fireplace which was screened. LPA observed that cleaning materials were inaccessible. LPA observed that there were no hazardous items accessible to children. LPA observed knives to be kept on top of the refrigerator and out of reach of the children in care. Licensee stated there are no weapons in the home. The fire extinguisher, smoke detector and carbon monoxide detector meet regulation. The home has dual smoke and carbon monoxide detectors installed. Toys appear to be safe. The backyard is fenced and gated. There are no bodies of water observed. During the inspection LPA reviewed COVID19 guidance and conducted a technical assistance tour of the facility to incorporate Department of Public Health safety protocols for operating during the pandemic. LPA discussed posting requirements and facility operations including sanitation and pick up/drop off procedures. Report Continues on 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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: ESQUIVEL, MARIA OLIVIA	FACILITY NUMBER: 394500249
	VISIT DATE: 06/30/2021

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

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 licensing requirements, including SB 277 (no longer accepting religious beliefs for immunization's) and SB 792 pertaining to immunization requirements for staff. In addition LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. In addition LPA discussed the infant sleep plan. LPA discussed the requirement for all infants 12 months and under to have a completed copy of LIC 9227 in the child's file. LPA provided a copy of LIC 9227 for licensee during today's inspection.

LPA discussed the Mandated Reporter Training with licensee and reminded licensee of the requirement to renew their training every two years. Volunteers are encouraged but not required to take the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws and regulations childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the licensee and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2