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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416851
Report Date: 04/10/2024
Date Signed: 04/10/2024 11:46:41 AM

Document Has Been Signed on 04/10/2024 11:46 AM - 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:VERGARA, ANGELAFACILITY NUMBER:
013416851
ADMINISTRATOR/
DIRECTOR:		VERGARA, ANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 477-9129
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
04/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Angela Vergara- LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 4/10/24, Licensing Program Analyst Briana Plumboy and Randy Miranda met with licensee Angela Vergara for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was 1 infant (licensees grandchild), 10 preschool age children, as well as licensees fingerprint clear and associated assistants Alicia Delizo and Ameila Veronica Medina, licensees fingerprint clear and associated mother Estelita Vergara, and licensees husband Ronaldo Padilla. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 6:00pm.

The home is single story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the sun room, family room, dining room, and hallway bathroom. The OFF LIMIT AREAS are the two bedrooms, the garage, and the master bedroom/bathroom which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the family room. The BACKYARD play area is fenced. There are toys and learning supplies/equipment. There are no pools, hot tubs or any other bodies of water present in the on limits areas during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children during today's inspection.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and assistant Ameila Veronica Medina's CPR and First Aid certificates are current and Angela's expires 10/28/25 and Ameila's expires 8/2025. The licensee's mandated reporter training is complete and she received a certification of completion on 1/17/24, assistant Amelia received her certificate on 8/28/23, and assistant Alicia completed her mandated reporter training certificate on 3/6/24. The licensee, her husband Ronaldo Padilla, and assistants present are in compliance with the immunization law. The fireplace is barricaded to prevent access by children. The licensee is documenting sleep checks. 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 1/31/24.

LPA Plumboy reviewed 5 children's files The licensee is in ratio today. REQUIRED forms are posted and visible for public review. See 809-C for continuance
Wynn Norona
Briana Plumboy
DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: VERGARA, ANGELA
FACILITY NUMBER: 013416851
VISIT DATE: 04/10/2024
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Licensee Angela Vergara 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 Angela Vergara 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
SUPERVISOR'S NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
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: VERGARA, ANGELA
FACILITY NUMBER: 013416851
VISIT DATE: 04/10/2024
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Licensee Angela Vergara 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 Angela Vergara 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 Angela Vergara 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 Angela Vergara 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 Angela Vergara.
SUPERVISOR'S NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
LIC809 (FAS) - (06/04)
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