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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009999
Report Date: 10/07/2021
Date Signed: 10/07/2021 05:40:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CUEVAS, DIANA FCCHFACILITY NUMBER:
493009999
ADMINISTRATOR:CUEVAS, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 774-2318
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:14CENSUS: 8DATE:
10/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Diana CuevasTIME COMPLETED:
04:55 PM
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A required - 1 year inspection was made to the facility by Licensing Program Analysts (LPA) Leticia Rosales-Meza. A review of staff records on 10/07/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. There is currently one adult living in the home.

During today’s inspection the home and grounds were toured. The licensee was supervising two infants, and six preschool age children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 6:00 AM to 6:00 PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The "off limits" areas of the home are the kitchen, dining room, living room and the second story of the home, which were made inaccessible by means of secured gates. The home was clean and orderly, and was at a comfortable indoor temperature of 68 degrees Fahrenheit. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 10/2022. The licensee's CA mandated reporter training certificate expires March 2023. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are stored in a closet, using a key locked door. There is a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A, 10:BC. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The children use 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 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. The in-ground swimming pool located in the backyard is surrounded by a five foot fence. The slats are 2.5 inches apart. The fence does not obscured the pool from view. There is a self closing and self latching gate that swings away from the pool.

(Continue to LIC 809-C)

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: CUEVAS, DIANA FCCH
FACILITY NUMBER: 493009999
VISIT DATE: 10/07/2021
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Ten children's (C1 and C8) records were reviewed at 2:40 PM; required emergency information was observed to be on file.

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.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Diana Cuevas.

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/process
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2