573607570-6-23-2022-53-CC-SMAY-CFNSNA-20220623140112

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573607570
Report Date: 06/23/2022
Date Signed: 06/23/2022 02:01:31 PM

Document Has Been Signed on 06/23/2022 02:01 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	LARA, GUADALUPE		FACILITY NUMBER:	573607570
ADMINISTRATOR:	LARA, GUADALUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 574-0121
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	14	CENSUS: 5	DATE:	06/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Guadalupe Lara		TIME COMPLETED:	02:10 PM

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On June 23, 2022, Licensing Program Analyst (LPA) Salene Mayberry and Licensing Program Manager Jeanne smith met with the Guadalupe Lara (Licensee) for the purpose of an unannounced annual random inspection. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing office. Capacity specified on the license was met on today’s inspection. Present in the facility were five children. LPA verified the annual fees are current. Facility hours of operation are 8:00 am to 5:00 pm Mondgaay through Friday.

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.

A health and safety inspection was conducted in all areas accessible to children. The home is a one-story house with four bedrooms, two bathrooms and a garage. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Facility maintains a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed that all hazardous and personal hygiene items are inaccessible to children. Licensee stated there are no weapons in the home. The outdoor play space is fenced and includes age appropriate toys and three play structures in good condition. There are no bodies of water on the premises. There is a shed with a locked door on the side yard.

Report continued on LIC809-C.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: LARA, GUADALUPE	FACILITY NUMBER: 573607570
	VISIT DATE: 06/23/2022

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Off-Limit areas are: master bedroom, laundry room, and garage. Licensee acknowledged that children are never allowed in the off-limit areas. Off limit areas will remain inaccessible by locked doors, gates and supervision. Safety latches are in used on some kitchen cabinets and bathroom cabinets and drawers. Licensee understands that she must ensure the safety latches are not broken.

LPA asked Licensee for the facility records which include children and Licensee’s file. Four children’s files were reviewed. All required forms for the children in care are complete and maintained in the file, with the exception of one child who needs updated immunization records. LPA observed a current roster. LPA discussed with Licensee the requirement that fire drills are conducted at least once every six months and provided a Fire Drill Log.

Current in person pediatric EMSA CPR and First Aid certification was verified and expires 3/16/2024. Licensee has not completed an AB1207 Mandated Reporter Training course. LPA discussed the requirement to complete this training and to renew the mandated reporter training every two years. As training is not currently offered in Spanish, LPA provided her with the Yolo County Resource and Referral contact information to assist her, as well as the mandated reporter training website: www.mandatedreporterca.gov.

Incidental Medical Services (IMS) policy was discussed. If any IMS is provided in the future, Licensee understand that a Plan for Providing IMS must be submitted to Licensing.

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

LPA discussed the safe sleep regulations with Licensee and provided 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.

Report continued on LIC809-C.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: LARA, GUADALUPE	FACILITY NUMBER: 573607570
	VISIT DATE: 06/23/2022

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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/process.

An Exit interview conducted and the report was reviewed with Licensee. LPA Mayberry posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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