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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423309
Report Date: 07/16/2021
Date Signed: 07/16/2021 04:15:30 PM

Document Has Been Signed on 07/16/2021 04:15 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DELGADO, LORENAFACILITY NUMBER:
013423309
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
07/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:23 PM
MET WITH:Lorena DelgadoTIME COMPLETED:
04:30 PM
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On July 16, 2021 at 2:23PM, Licensing Program Analyst (LPA) Catherine Fernandes conducted an unannounced Required Inspection. LPA Fernandes was greeted by Licensee Lorena Delgado, there were no children in care during todays inspection. Residing in the home is the Licensee her underage child. Operating hours will be 8:00AM to 5:00PM, Monday through Friday. Licensee has seven children currently enrolled in the day care.

The home is a single story house that consists of three bedrooms and one bathroom. The OFF LIMIT AREAS are the master bedroom, the garage and the shed in the backyard, which will be inaccessible by closed and/or locked doors or visual supervision. The ON LIMIT AREAS are the living room/dining room combo which is the main area of the day care, the bathroom, the laundry area which will be utilized as a walk through space (also has a gate), the kitchen, the bedroom next to the kitchen, the bedroom off the main area of the day care and the fenced in backyard. The ISOLATION AREA will be the couch in the converted bedroom next to the kitchen. Outdoor play area will be in the fenced backyard. There are toys and play equipment for the children that appear clean safe and in good repair. There are no pools, hot tubs or any other bodies of water during today's inspection. Licensee has one small dog on the property that is around the children.

The home has a fully charged 3A40BC fire extinguisher next to the kitchen, a working smoke detector in the main area of the day care and a working carbon monoxide detector in the dining room. Licensee has a working telephone and complete First Aid Kit. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 6/11/2021. The Licensee's CPR and First Aid certificate is current and expires on 2/15/2022. There is a fire place in the living room that is covered to prevent access by children. Per Licensee, there are no firearms in the home. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for child care providers, which has been completed on 11/31/2021. REPORT CONTINUES ON LIC 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: DELGADO, LORENA
FACILITY NUMBER: 013423309
VISIT DATE: 07/16/2021
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Four of the seven children's files were reviewed and complete.

Incidental Medical Services (IMS) policy was discussed and Licensee is not providing IMS as of today.

Licensee has submitted COVID-19 Self-Assessment Guide.  LPA reviewed responses with licensee and provided technical assistance and postings were posted during todays inspection.

The Licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.



California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.



There are no deficiencies cited today.
The report will remain on file for three years.
An exit interview was conducted with Licensee.
Report, Appeal Rights and Notice of site visit were provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC809 (FAS) - (06/04)
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