434412453-9-9-2021-52-CC-BPLY-C6PTNW-20210909145324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412453
Report Date: 09/09/2021
Date Signed: 09/09/2021 10:35:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PEREZ, BADRO LILIA		FACILITY NUMBER:	434412453
ADMINISTRATOR:	PEREZ, BADRO LILIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 518-2244
CITY:	ALVISO	STATE: CA	ZIP CODE:	95002
CAPACITY:	14	CENSUS: 1	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Badro Lilia Perez- Licensee		TIME COMPLETED:	03:08 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	On 9/9/21 at 12:31pm, Licensing Program Analyst Briana Plumboy, met with licensee Badro Lilia Perez for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 1 preschool age child, and licensee's husband whom is fingerprint cleared and associated to the facility. LPA Plumboy provided licensee with form Lic. 126. The home was toured upon entrance by LPA Plumboy and licensee to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:00am until 5:30pm. LPA observed no stairs inside the home. LPA observed the storage units and part of the garage at the lower level have been converted to an apartment. LPA observed the apartment is leased to two tenants. Off limits indoor: bedroom located at the end on the left side of the hallway, master bedroom/master bathroom, hallway bathroom, garage, and the downstairs apartment unit. As of 9/9/21, the first bedroom located on the left side of the hallway is on limit. The garage and the apartment unit have separate entrances from the upper level of the main house. There are no bodies of water present in the on limit areas during today's inspection. Licensee stated there are no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children during today's inspection. The backyard play area is fenced. LPA observed the backyard is at the lower level of the house. Licensee understands that the children will be escorted to and supervised when playing in the backyard. Children also play in the front deck area. Licensee understands that the security door to the outdoor stairs shall remain closed when children are outside in the front deck area. LPA observed 2 locked storage sheds in the backyard. Off limits outdoor: left upper deck and fenced off lower level right side yard. The home has a fully charged 4A60BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 01/23/23. The licensee's mandated reporter training is complete and she received a certification of completion on 12/18/20. The licensee is in compliance with the immunization law. The home has centralized heating. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 4/7/21. At 2:02pm, LPA Plumboy was provided with a copy of the roster and reviewed it for completion. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREZ, BADRO LILIA	FACILITY NUMBER: 434412453
	VISIT DATE: 09/09/2021

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. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

LPA discussed the safe sleep regulations with licensee Badro Lilia Perez 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 Badro Lilia Perez 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Badro Lilia Perez.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2