493009999-8-11-2021-01-CC-LROS-C5SS3N-20210811133126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009999
Report Date: 10/16/2020
Date Signed: 08/11/2021 01:31:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	CUEVAS, DIANA FCCH		FACILITY NUMBER:	493009999
ADMINISTRATOR:	CUEVAS, DIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 774-2318
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	14	CENSUS: 0	DATE:	10/16/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Diana Cuevas		TIME COMPLETED:	03:45 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	A Zoom video conference (change of location) Pre-Licensing inspection was conducted today by Licensing Program Analyst (LPA), Leticia Rosales-Meza. The applicant is Spanish Speaking. Due to the COVID-19, the Department has suspended all field operations, and the applicant agreed to attend the Tele-Inspection conference with LPA. The applicant was previously licensed at 153 Arlington Dr., Petaluma, CA 94952. The applicant is requesting a license for a capacity of 8 children. Services will be provided Monday - Sunday 12:00 AM - 11:59 PM. The applicant understands that 24hr consecutive care is prohibited. The applicant understand that childcare must be provided in the "primary" residence of the applicant. The residence is a two story level four bedrooms, two in a half bath home. There are two adults and one minor living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. During the Tele-Inspection, the applicant provided a virtual tour of the entire facility and backyard. The day care space is the family room, downstairs half bathroom, and garage (day care space). The kitchen, dining room, living room and the second story are "off limits" to the day children, and were made inaccessible by secured gates. The floor plan submitted by the licensee was reviewed and verified. During the video LPA observed electrical outlets were covered and drapery cords are not accessible. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The applicant stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's Tele-Inspection. The children will use the front yard as the outdoor play and is fully fenced. The backyard is completely "Off limits". There is an in-ground pool located in the back yard. There is no fence surrounding the pool observed during the video inspection. There are alarms installed on the sliding doors in the family room and kitchen. The sliding door in the family room is also latched and bolted on top of sliding door.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: CUEVAS, DIANA FCCH	FACILITY NUMBER: 493009999
	VISIT DATE: 10/16/2020

NARRATIVE

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Pediatric CPR and Pediatric First Aid cards expire on 10/2022 for Applicant and assistant. All licensing reports are public information and must be made available upon request for at least three years.

Based on today's video inspection, the facility does not meets licensing requirements due to the in-ground pool.

LPA discussed with applicant the requirements and regulations for a swimming pool and of the fence with self closing, and self latching gates that open away from the pool. The gate material must meet Title 22 regulation requirements. Fence material openings shall be no larger that a golf ball, and prevent a child from climbing the gate and fencing material.

1. Provide evidence that pool complies with Title 22 fencing requirements.

The applicant stated she will comply with these regulations. Licensee stated she will submit photos and will call LPA when she has installed the fence.

The Applicant's signature was not recorded on this Facility Evaluation Report (LIC 809 & LIC 809-C), however, the Applicant was provided with a copy of this report; and the Applicant's proof of Read Receipt is on file. LPA also mailed a copy of this report to the Applicant.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC809 (FAS) - (06/04)

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