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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500299
Report Date: 12/11/2020
Date Signed: 12/11/2020 04:17:17 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:PEREZ, BEATRIZFACILITY NUMBER:
574500299
ADMINISTRATOR:PEREZ, BEATRIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 582-5716
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 0DATE:
12/11/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Beatriz Perez TIME COMPLETED:
02:00 PM
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Due to the COVID-19 pandemic Licensing Program Analyst (LPA) Marissa Soto met with applicant Beatriz Perez for the purpose of a Pre-Licensing inspection Tele-Visit via FaceTime on December 11, 2020 at 11:30 am in lieu of conducting a Pre-Licensing site inspection. During today's Tele-Visit inspection the Applicant and Applicant's children were present in the home. LPA and Applicant toured the entire 1 story home both inside and out. The facility consists of 3 bedrooms, 3 bathrooms, kitchen, living room, laundry room, garage and fenced backyard. Off limit areas will consist of all bedrooms and master bathroom.


Applicant owns the home. LPA obtained a copy of the mortgage statement to show control of property. City of West Sacramento Fire Department, Adeline Wright, conducted their inspection and cleared the facility on November 23, 2020. Applicant's CPR and First aid certification was verified. LPA reviewed required forms for children's records including immunization card and proposed Safe Sleep Regulation Concepts. LPA also provided the Parent's Rights form/poster, new regulations were reviewed which include seat belt/booster seat laws, vaccination requirements for staff and children, and smoking prohibition. 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

There were no bodies of water at the home. Kitchen cabinets are latched, and cleaning compounds, knives and medications are inaccessible to children.

(report continued next page, LIC 809-C)
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2020
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: PEREZ, BEATRIZ
FACILITY NUMBER: 574500299
VISIT DATE: 12/11/2020
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LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. LPA advised the applicant that it there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

Applicant has completed the required AB1207 Mandated Reporter training. Applicant understand that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Applicant is informed all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee was informed about the Provider Information Notices (PINs) on CCLD website.

This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of today 12/11/2020 facility is approved for a Large Family Child Care Home license serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or elementary school and 1 child at least age 6 years old with a maximum of 3 infants.

A copy of this report was emailed to the Licensee. Hard copy of the report with signature will remain on file.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2020
LIC809 (FAS) - (06/04)
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