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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415580
Report Date: 06/04/2024
Date Signed: 06/04/2024 01:20:17 PM

Document Has Been Signed on 06/04/2024 01:20 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GUZMAN, SANDRAFACILITY NUMBER:
013415580
ADMINISTRATOR/
DIRECTOR:		GUZMAN, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 441-2059
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
06/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Sandra Guzman- LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 6/4/24, Licensing Program Analyst Briana Plumboy met with licensee Sandra Guzman for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was licensees assistant Edith Henriquez, a teenage assistant, 3 infants, 3 preschool age children, and 2 school age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00am until 5:30pm.
The home is a 2 stories. The home is neat and clean with heating and ventilation for safety and comfort. The families enter the daycare through the gate located on the right side of the home. The ON LIMIT AREAS are the downstairs hallway bathroom, the bedroom located off the bathroom, the family room, the right side of the dining room, and the backyard. The OFF LIMIT AREAS are the living room, kitchen, the left side of the dining room, garage, downstairs bedroom, and entire second level which will be inaccessible by closed and/or locked doors and visual supervision. There are stairs located inside the home located inside the living room next to the front door. Per licensee, the children enter and exit through the family room and backyard, and at no time are near the stairs. The ISOLATION AREA will be the right side of the dining room. The BACKYARD play area is fenced. There are toys and learning materials present during today's inspection. There are no pools, hot tubs or any other bodies of water present at the facility in the on limit areas during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and pull down fire alarm. The licensee and assistant Edith's CPR and First Aid certificates are current and expire 4/8/25. The licensee and assistant Edith both received certificates in mandated reporter training, with licensee Sandra receiving her certificate on 2/26/23 and Edith received her certificate on 2/27/23. The licensee and assistant Edith Henriquez are in compliance with the immunization law. Licensee is documenting infant sleep checks. There are no fireplaces or wall heaters located inside the home. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 2/15/24.
Facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GUZMAN, SANDRA
FACILITY NUMBER: 013415580
VISIT DATE: 06/04/2024
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Licensee Sandra Guzman is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Licensee Sandra Guzman was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GUZMAN, SANDRA
FACILITY NUMBER: 013415580
VISIT DATE: 06/04/2024
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Licensee Sandra Guzman was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with licensee Sandra Guzman and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed licensee Sandra Guzman 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.

During the exit interview, the Licensee Sandra Guzman confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Sandra Guzman.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
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