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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423691
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:55:11 AM

Document Has Been Signed on 11/09/2022 11:55 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ROJAS, ANGELINAFACILITY NUMBER:
013423691
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angelina RojasTIME COMPLETED:
12:05 PM
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Licensing Program Analyst Lisa Dyer conducted an announced pre-licensing inspection. Present were the applicant and her fingerprint cleared husband. The home was toured for a Health and Safety Inspection.
Facility Location: At 8:45 a.m., the following was observed: The home was toured and consists of 4 bedrooms, 2 bathrooms, living room, dining room, laundry room and kitchen. Applicant will be utilizing the living room, 2 bedrooms and 1 bathroom for her day care area. Off limits areas are the dining room, kitchen, 2 bedrooms, and 1 bathroom. These areas will be inaccessible by closed and/or locked doors; gates and visual supervision.
Facility Review: Home is neat and clean, with ventilation for safety and comfort. Children will sleep on cots or playyards. There is child-sized furniture, toys and play space at the facility. There are 2 fingerprint cleared adults that live in the home. Isolation area for sick children will be in the Sleep Room. There are no toxins accessible today. There is a 3-A:40-B:C fully charged fire extinguisher, a working smoke detector (tested), carbon monoxide detector (tested), thermometer and a first aid kit.
Per applicant, there are no firearms on the premises. Applicant has a small kidney shaped pond in the front of the home that is approximately 30 x 48 inches. Applicant was told that she would have to either remove the pond or childproof the pond to insure that children are safe in the area. Fireplace is blocked and screened. Applicant has a cell phone. Backyard is securely fenced. Pets consist of 3 medium sized bull terriers.
Applicant Training: Applicant has completed Preventative Health Training on 5/18/18. CPR/First Aid Training expires November 2023. Mandated Reporter Training certificate expires December 2023. Applicant is the owner of the property, and verification was viewed.
Technical Assistance During Inspection: LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted. 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 (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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: ROJAS, ANGELINA
FACILITY NUMBER: 013423691
VISIT DATE: 11/09/2022
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(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.
Applicant was instructed to conduct and document periodic fire and disaster drills. Discipline methods were discussed. Applicant was instructed that spanking is not allowed. Proposed hours of operation: 8:00 am - 5:00 pm.
LPA discussed the safe sleep regulations with the applicant, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the Unites 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. The handout, "A Child Care Provider's Guide to Safe Sleep" was also provided and discussed.
Applicant was informed that baby bouncers, johnny jumpers, and saucer chairs were not allowed in the home. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Also discussed: children in parked vehicles; substitutes; training videos; changes to the facility; fingerprinting/association; advertisements; on-limit areas, large family child care homes, and smoking. Applicant was reminded that Mandated Child Abuse Training, as well as First Aid/CPR training is required to be completed every 2 years.

It was specifically discussed with the applicant that the outdoor sandbox area could not be used as the area around it is not safe for child play. Applicant will need to keep this area closed until it is reinspected.

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.
(continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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: ROJAS, ANGELINA
FACILITY NUMBER: 013423691
VISIT DATE: 11/09/2022
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To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Or, For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address for the Child Care Advocate Program.

Applicant was given Title 22 regulations, and was requested to enroll in Guardian Background Check to manage their employee roster and manage the background check process.

Websites:
Community Care Licensing: https://www.cdss.ca.gov
Mandated Reporter Training - www.mandatedreporterca.com. (Child Care Providers Module).
Alameda County Public Health Department Website: www.acphd.org
Guardian Background Check: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

The applicant was requested to complete the following item(s) prior to the issuance of a license:
1. Cover sandbox area in backyard.
2. Place lock on hall door.
3. Insure that day care area is heated at a comfortable temperature for children in care.
4. Remove baby walker.

Applicant states that items will be completed within 10 calendar days. (Additional information may be requested.)

Exit interview conducted and report was reviewed with the applicant Angelina Rojas. Appeal rights were given.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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