394500391-3-24-2021-53-CC-CJAN-BZF2H5-20210324172409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500391
Report Date: 03/24/2021
Date Signed: 03/24/2021 05:25:15 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:	CHAVEZ, IVON		FACILITY NUMBER:	394500391
ADMINISTRATOR:	IVON CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 923-0648
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	14	CENSUS: 0	DATE:	03/24/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Ivon Chavez		TIME COMPLETED:	05:30 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	Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Christopher Jackson is conducting a tele-video inspection via FaceTime with the Applicant Ivon Chavez. The purpose of today's visit is to conduct a change of location inspection for a large family home day-care. All adult individuals subject to criminal background review have obtained a criminal record clearance and are cleared through the department. During the FaceTime inspection, LPA Jackson conducted a health and safety tour of the home. LPA and applicant toured all areas of the single story home. The home consists of three bedrooms, two bathrooms, living room, dining room, kitchen, and laundry room. The applicant stated the off limit areas will be: Bedroom #1, Master Bedroom, Laundry Room and, Garage. The applicant understands that children are not allowed access to off limit areas. The home has a fully fenced in backyard with play equipment for children in care. LPA observed toxins and dangerous items were made inaccessible. LPA observed knives to be kept in a lock box in the upper kitchen cabinets. LPA observed a decorative space heater fireplace in the home. Licensee stated the front does not get hot as it is for decoration. LPA discussed visual supervision around the decorative space heater fireplace if used while children are in care. Applicant stated there are no weapons in the home. LPA observed applicant’s CPR/First Aid certification expires 01/2023. The department received the fire clearance on 03/18/2021 from the Manteca Fire Department clearing the home for a large Family Child Care. In addition, LPA observed working smoke alarm, carbon monoxide detector and fire extinguisher which meet Title 22 regulations. LPA reviewed licensing forms and provided the licensing website, www.ccld.ca.gov, so applicant may download forms, or review regulations. 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: 03/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2021

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: CHAVEZ, IVON	FACILITY NUMBER: 394500391
	VISIT DATE: 03/24/2021

NARRATIVE

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During the inspection LPA reviewed new COVID-19 self assessment guide 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.

During today's Tele-Visit LPA discussed with applicant the requirement for licensees to provide proof of completion for the Lead Exposure training. LPA informed applicant a provisional license will be granted, but applicant must complete the Lead training for final licensure.

An exit interview was conducted with Mrs. Chavez via Telephone call. LPA provided the facility with a copy of this report via email on 03/24/2021. Mrs. Chavez agreed to acknowledge receipt of the email, which will serve in lieu of a signature on this report

As of 03/24/2021 a provisional license will be granted to the large family child care license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children with 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

Licensee must provide proof of completion for the Lead component training to LPA within 90 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2021

LIC809 (FAS) - (06/04)

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