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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423838
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:22:56 AM

Document Has Been Signed on 10/17/2022 10:22 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:LAFITTE, ILEITAFACILITY NUMBER:
013423838
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ileita LafitteTIME COMPLETED:
10:37 AM
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On October 17, 2022 Licensing Program Analyst (LPA) Indira Loza met with applicant Ileita Lafitte to conduct a Change of Location inspection. The hours of operation will be 6am-6pm Monday through Friday.

The home is an apartment on the lower level of a duplex building. The home consists of three bedrooms, one bathroom, a kitchen, a dining area, and a living room. The Off Limit areas will be the Applicant's bedroom on the left from the hallway, and the kitchen. Applicant will ensure the off limit areas will be inaccessible by closed and/or locked doors, safety gates and visual supervision. The On Limit areas are the bedroom on the right from the entrance, the living room and dining room, the bathroom, and the bedroom at the end of the hallway. The isolation area will be in the bedroom to the right from the entrance. The backyard will be used for outdoor play. There are two storage sheds in the backyard which are locked and inaccessible to children.

The applicant plans of providing food for the children. Applicant stated there are no firearms in the home. The applicant plans on having Liability insurance. LPA observed a working carbon monoxide detector and a working smoke detector. There is a working phone in the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. The applicant has a current Mandated Reporter Certificate which expires on 5/31/2024. The applicant also has a current CPR/First Aid certificate which expires on September 2024. The applicant has a fully charged 3A40BC fire extinguisher.

LPA discussed the safe sleep regulations with the Applicant, and discussed the Child Care Licensing Safe Sleep web page 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
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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: LAFITTE, ILEITA
FACILITY NUMBER: 013423838
VISIT DATE: 10/17/2022
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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.

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.

Individual 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.



Effective today, October 17, 2022, the License will be placed on Active status.
Exit Interview conducted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC809 (FAS) - (06/04)
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