013423568-1-6-2022-02-CC-ASIH-CAEU4G-20220106141507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423568
Report Date: 01/06/2022
Date Signed: 01/06/2022 02:15:37 PM

Document Has Been Signed on 01/06/2022 02:15 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:	RODRIGUEZ, SILVIA		FACILITY NUMBER:	013423568
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	01/06/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Silvia Rodriguez		TIME COMPLETED:	02:15 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 01/06/2022 at 01:00 PM Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Silvia Rodriguez and her Assistant for an announced Capacity Increase inspection. There are 2 children present today. Days and hours of operation are Mon - Friday, 8:00AM to 5:00 PM. The home is a single story apartment, which is neat and clean with heating and ventilation for safety and comfort. The home consists of a living room, kitchen, 5 bedrooms, 2 bathrooms, main activity/classroom with small kitchen area, and fully fenced front yard. The OFF LIMIT AREAS are the room immediately to the left of the child care entrance, which is used as storage for supplies and toys, the living room, the two bedrooms and bathroom that are located close to the kitchen, and the kitchen which will be inaccessible by gate, closed and/or locked doors and visual supervision at all times. The ON LIMIT AREAS are the bathroom located directly across the child care entrance, the room adjacent to the on limits bathroom, and the room adjacent to the living room. The ISOLATION AREA will be the area close to the entry way to the child care rooms. The outdoor play area will be the fenced front yard where visual supervision will be required at all times. The outdoor play area is free from defects or dangerous conditions. There are ample age appropriate toys that are safe and appear to be clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked First Aid Kit. The Licensee’s Health and Safety training is completed and CPR and First Aid certificate is current as well as mandated reporter training.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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: RODRIGUEZ, SILVIA	FACILITY NUMBER: 013423568
	VISIT DATE: 01/06/2022

NARRATIVE

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This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual.

REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.
"Mandated Reporter" training for CA Child Care Providers that all staff are required to complete as of January 1, 2018. [Starting May 2019, both General Training followed by Child Care Providers Training is required to be taken]. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

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SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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: RODRIGUEZ, SILVIA	FACILITY NUMBER: 013423568
	VISIT DATE: 01/06/2022

NARRATIVE

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Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

The Home is Recommended for Capacity Increase effective 01/06/2022.

Exit Interview was conducted, where this report was reviewed and discussed with Licensee and Assistant. Report was signed by the Licensee confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

END OF REPORT

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC809 (FAS) - (06/04)

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