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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573617494
Report Date: 08/12/2019
Date Signed: 08/12/2019 03:40:11 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:SOLORZANO, MARIAFACILITY NUMBER:
573617494
ADMINISTRATOR:SOLORZANO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 406-8759
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY:14CENSUS: 4DATE:
08/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria SolorzanoTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Chayntel Hunter and Licensing Program Manager (LPM) Sharon Ogbodo met with Licensee, Maria Solorzano and daughter, Patricia Solorzano for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. There were four infants at the time of visit.

A health and safety inspection was conducted in all areas accessible to children. Off-limits area include the garage. LPA and LPM observed a fence to section off a portion of the side yard. LPA and LPM observed the license and parents rights postings, a working phone, 2A10BC 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 Hunter observed a fireplace that was blocked off by a large screen in the living room. Outdoor play space is fenced.

Two children's' file were reviewed. Emergency information and required immunization records were on file. Licensee immunization were not verified and not available in facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 02/2021.

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.

LPA and LPM verified the annual fees are current.

Report continues on 809-C.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SOLORZANO, MARIA
FACILITY NUMBER: 573617494
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2019
Section Cited
HSC
1597.622(a)(1)
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A person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licesnsee stated she will email the proof of immunization record for her and her daughter to LPA Hunter
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This requirement was not met as evidenced by: LPA and LPM did not obsserve Licensee or licesnee's daughter's immunnization records for Tdap, MMR, or Influenza.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: SOLORZANO, MARIA
FACILITY NUMBER: 573617494
VISIT DATE: 08/12/2019
NARRATIVE
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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.

LPA Hunter provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Licensee can request to be added to the distribution list to receive Quarterly Updates. LPAs provided and discussed the Safe Sleep in Child Care brochure.

This facility evaluation report was reviewed and discussed with Licensee. Licensee was encouraged to visit the Department website at WWW.CDSS.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.



A Title 22 DEFICIENCY was cited on the subsequent page LIC 809-D of this report. Appeals rights were discussed and printed. An exit interview was conducted. A Notice of Site Visit was was provided and should remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3