483009678-5-27-2020-01-CC-MAUN-BPZU5U-20200527151719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009678
Report Date: 04/28/2020
Date Signed: 05/27/2020 03:17:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	JIMENEZ, FABIOLA FCCH		FACILITY NUMBER:	483009678
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/28/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Fabiola Jimenez		TIME COMPLETED:	09:40 AM

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) Melchisedeck Augustin conducted a Zoom video conference Tele-Inspection with the Licensee Fabiola Jimenez, for the purpose of increasing the facility’s capacity to 14. Due to COVID-19, the Department has suspended all field operations, and the licensee has agreed to meet with LPA via video conference. On 04/21/20, the Vallejo Fire Department granted the facility a fire clearance to operate at a capacity of 14. A review of staff records on 04/28/20 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently three adults living in the home. During the Tele-Inspection, the licensee provided a virtual tour of the facility’s on limits areas. The on limits area includes, the main day care room, nap room, living room and bathroom on the second level, and the backyard. The off-limits areas of the home are three bedrooms & two bathrooms on the third level, and the garage; and were made inaccessible by a child safety gate and plastic doorknob cover. The facility’s operating hours are 7:00am to 6:00pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The licensee did not have any children in care and was operating within the licensed capacity and ratio requirements. The home was observed to be clean and orderly. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed and expire on 04/2020. The licensee did not have proof of upcoming course registration, however, the licensee agreed to submit proof of Pediatric CPR and First Aid course registration to the Department. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Poisons were locked in the outdoor shed. The staircase that leads to the family room, to the third level; and staircase in the backyard were barricaded with children's safety gates. The fireplace has been made inaccessible with a latched screen. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's Tele-Inspection. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2020

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,
, CA

FACILITY NAME: JIMENEZ, FABIOLA FCCH	FACILITY NUMBER: 483009678
	VISIT DATE: 04/28/2020

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

The children use the backyard as the outdoor play area, and the yard it is fully fenced. The driveway located left of the home was made inaccessible with a child’s safety gate. There were no pools or other bodies of water observed.

The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. LPA provided AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures to the licensee. All licensing reports are public information and must be made available upon request for at least three years. The Licensee's signature was not record on this Facility Evaluation Report (LIC 809 & LIC 809-C), however, the Licensee was provided with a copy of this report; and the Licensee's proof of Read Receipt is on file.

There were no Title 22 deficiencies cited during today's inspection.

The license to operate a Large Family Child Care Home is pending and the following needs to be completed prior to increasing the facility’s capacity. Please include facility number in all correspondence.

1. Licensee’s current and valid CPR and First Aid certification.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2