013423836-1-20-2023-02-CC-PDYR-CN9QTP-20230120112727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423836
Report Date: 01/20/2023
Date Signed: 01/20/2023 01:13:42 PM

Document Has Been Signed on 01/20/2023 01:13 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:	NAVARRO NOLAZCO, PERLA & VALDEZ NAVARRO, ZAYRA		FACILITY NUMBER:	013423836
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	01/20/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Perla Navarro Nolazo and Zayra Valdez Navarro		TIME COMPLETED:	11:37 AM

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	Licensing Program Analyst Lisa Dyer conducted an announced pre-licensing inspection. Present were the two applicants, who are mother and daughter. Daughter translated for her mother. The home was toured for a Health and Safety Inspection. Applicants are fingerprint cleared. There are a total of 3 fingerprint cleared adults that live in the home. 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, and kitchen. Applicants will be utilizing the living room and the bathroom for their day care area. Off limits areas are 4 bedrooms, one bathroom, dining room and the kitchen. These areas will be inaccessible by closed and/or locked doors; door knob covers; gates and visual supervision. Facility Review: Home is neat and clean, with heating and ventilation for safety and comfort. Children will sleep on cots or cribs. There is child-sized furniture, toys and play space at the facility. Isolation area for sick children will be in the living room. There are no toxins accessible today. Knives are located in the kitchen, inaccessible to children. There is a 2-A:10-B:C fully charged fire extinguisher, a working smoke detector (tested), carbon monoxide detector (tested) and a first aid kit. Per applicant, there are no firearms, bodies of water or pets on the premises. Fireplace was blocked by play equipment. Applicant has a cell phone. Backyard is securely fenced. There does not appear to be any dangerous hazards in the backyard such as poisons or toxins. Applicant Training: Applicants have completed Orientation Training and Preventative Health Training. Applicant's Mandated Reporter Training expires 9/05/24 and CPR/First Aid Training expires April/August 2024. Applicant is renting 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. (continued)

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: NAVARRO NOLAZCO, PERLA & VALDEZ NAVARRO, ZAYRA	FACILITY NUMBER: 013423836
	VISIT DATE: 01/20/2023

NARRATIVE

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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: 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. Applicant plans to provide continuous care.
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; 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.

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-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 (Child Care Advocate Pgm).cont.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: NAVARRO NOLAZCO, PERLA & VALDEZ NAVARRO, ZAYRA	FACILITY NUMBER: 013423836
	VISIT DATE: 01/20/2023

NARRATIVE

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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

It is recommended that a license be issued to this Family Day Care Home pending receipt of all final clearances and the completion of all requirements. This license will be effective today, January 20, 2023.

Exit interview conducted and report was reviewed with the applicants Perla Navarro Nolazco and Zayra Valdez Navarro. Appeal rights were given.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

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