573611118-7-22-2021-53-CC-CHUR-C56PSA-20210722113402

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573611118
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:34:11 AM

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:	LICEA, ANTONIETA		FACILITY NUMBER:	573611118
ADMINISTRATOR:	LICEA ANTONIETA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 668-5846
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95776
CAPACITY:	14	CENSUS: 8	DATE:	07/22/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee Antonieta Licea		TIME COMPLETED:	11:40 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	On July 22, 2021, Licensing Program Analyst (LPA) Chayntel Hunter met with Licensee, Antonieta Licea for the purpose of an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. There were eight children present at the time of inspection. Licensee's daughter/assistant was also present during the inspection. Licensee's operating hours are Monday through Friday from 5:30 AM. to 5:30 PM. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the entire upstairs, basement, dining room, and the left grass side of the yard. Off limit areas are being made inaccessible by closed locked doors and baby gates. LPA observed the required postings and a working phone. 3A10BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA observed knives and cleaners to be stored in an area inaccessible to children in care. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPA observed living room area with age appropriate toys for children. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. In addition LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutues for infants 24 months and under. 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. EMSA pediatric CPR and First Aid certification and Child Care Provider Mandated Reporter certification was discussed. Licensee was reminded to renew both courses every two years. 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: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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

FACILITY NAME: LICEA, ANTONIETA	FACILITY NUMBER: 573611118
	VISIT DATE: 07/22/2021

NARRATIVE

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LPA reviewed new COVID19 self-assessment guide and conducted a technical assistance tour of the facility to incorporate Department of Public Health safety protocols for operating during the pandemic. LPA discussed posting requirements and facility operations including sanitation and pick up/drop off procedures.

LPA verified the annual fees are current.

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 childcare 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. Appeal rights were printed and provided.

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: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC809 (FAS) - (06/04)

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