434412453-5-24-2023-52-CC-MESA-CS5RDN-20230524125613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412453
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:56:55 PM

Document Has Been Signed on 05/24/2023 12:56 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, 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: 5	DATE:	05/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lilia Perez		TIME COMPLETED:	01:00 PM

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On Wednesday, May 24, 2023, at 11 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year Visit. LPA met with the Licensee and explained the nature of the site visit. Present on this visit were Licensee's Assistants Maria and Nataly, 2 preschool child and 3 infants. The facility currently operates Monday through Friday from 8:00am until 5:30pm.

The home was toured to conduct a Health and Safety Inspection. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort. LPA observed gated stairs to access the On-Limit Area (second story) from the driveway.

The ON LIMIT AREAS (accessible to children in care) are the one bedroom (napping area for infants) across the hallway bathroom located in the second story, living room located in the second story, family room located in the second story, laundry (diaper changing area) and half bathroom next to the kitchen located in the second story, kitchen located in the second story, second story front deck which is gated and the backyard. The BACKYARD play area is completely 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.

The OFF-LIMIT AREAS are all remaining 2 bedrooms located on the second floor, master bath, rear deck located on the second floor, the converted apartment on the first floor being leased by the Licensee's son, fenced off lower-level right side yard and the garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. The designated isolation area for a child who becomes ill while in care is the living room.

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREZ, BADRO LILIA	FACILITY NUMBER: 434412453
	VISIT DATE: 05/24/2023

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Continuation.

There are ample age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today LPA observed First Aid Kit located in the Family Room. Licensee stated that she does not transport children at this time.

The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Licensee owns the house and has childcare liability insurance with DCI.

The Licensee and Licensee's Assistants have records of CPR and First Aid certificate, Mandated Reporter Training Certificates and Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Sleep Logs, LIC 9227 and Immunization. The licensee is in ratio today.

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

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 05/24/2023

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Continuation.

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.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There are no deficiencies cited on this visit.

Exit interview conducted and report was reviewed with the licensee, Lilia Perez.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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