573607523-1-27-2020-53-CC-CHUR-BL8STY-20200127131018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573607523
Report Date: 01/27/2020
Date Signed: 01/27/2020 01:10:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MEZA, ROSA		FACILITY NUMBER:	573607523
ADMINISTRATOR:	MEZA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 669-7670
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95776
CAPACITY:	14	CENSUS: 1	DATE:	01/27/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Licensee, Rosa Meza		TIME COMPLETED:	01:20 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	Licensing Program Analyst (LPA) Chayntel Hunter met with Licensee, Rosa Meza for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Census at the time of inspection was 1 child. Licensee's operating hours are Monday through Sunday from 6:00 AM to 6:00 PM. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: all bedrooms, laundry room and garage. LPA observed the required postings, a working phone, 3B40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. LPA observed a fireplace that was covered by a screen. Outdoor play space is fenced. Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 02/2021 and Child Care Provider Mandated Reporter was verified and expires 02/2021. LPA verified the annual fees are current. LPA provided and discussed the Safe Sleep in Child Care brochure. Report continues on 809-C.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MEZA, ROSA	FACILITY NUMBER: 573607523
	VISIT DATE: 01/27/2020

NARRATIVE

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This provider is not currently providing IMS services to children in care. 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.

This facility evaluation report was reviewed and discussed with Licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020

LIC809 (FAS) - (06/04)

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