<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500413
Report Date: 08/05/2021
Date Signed: 08/05/2021 12:19:39 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:BARRERA, JOSEPHINEFACILITY NUMBER:
574500413
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
08/05/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Josephine BarreraTIME COMPLETED:
12:35 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
On August 5, 2021, at 10:00am, Licensing Program Analyst (LPA) Marissa Soto met with applicant Josephine Barrera for the purpose of a pre-licensing inspection. During today's inspection the Applicant and Applicant's children were present in the home. LPA observed Applicant supervising 3 children (Ages: 7 years old, 4 years old, and 9 months). LPA and Applicant toured the entire 2 story home both inside and out. The facility consists of 4 bedrooms, 3.5 bathrooms, living room, family room, kitchen, laundry room, garage and fenced backyard. Off limit areas will consist of all of the upstairs, the room down stairs, garage and closet under stairs. Applicant rents the home. Facility file contains rental agreement. Applicant's CPR and First aid certification was verified.

LPA reviewed required forms for children's records including immunization card and 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

(report continued on next page, LIC809C)
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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 2