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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700059
Report Date: 11/03/2021
Date Signed: 11/09/2021 03:18:28 PM

Document Has Been Signed on 11/09/2021 03:18 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:RODRIGUEZ, YSGLEEFACILITY NUMBER:
015700059
ADMINISTRATOR:RODRIGUEZ, YSGLEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-3779
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 4DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Ysglee RodriguezTIME COMPLETED:
01:36 PM
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On 11/03/2021 at 10:52am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Ysglee Rodriguez for an Unannounced Annual Inspection. Present during the inspection was the Licensee, her fingerprint cleared helpers (mother Isbelia D., and sister Ysabel R.). There was one (1) infant, three (3) preschool age children and one (1) child age thirteen (13) present during the inspection. Licensee lives in the home with her mother and two (2) sons age ten (10) and eight (8). Licensee’s home was toured for a health and safety inspection. The facility operates 24hours Monday - Saturday.

ON LIMITS AREA: Entire 2nd floor (Family Room, Living Room, Kitchen, Dining Room, Bathroom and Bedroom) and Backyard


OFF LIMITS AREA: Entire 1st floor and 3rd floor
ISOLATION AREA: Bedroom or living room

The facility is a three-story home rented by the Licensee. The inside and outside of the home are observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas.

The home has one (1) fully charged 3A40BC fire extinguisher in the kitchen. There is one (1) working smoke/carbon monoxide detector in the hallway by the dining room, the bedroom and in the hallway by the bathroom. The home is equipped with central heating and air for proper ventilation. The electric fireplace in the family room has been blocked and disconnected, making it inaccessible to the children in care. The stairways to the first and third floor have been gated for the children’s safety as well. Licensee stated there are no firearms and no pets in the home.

Continued on LIC809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, YSGLEE
FACILITY NUMBER: 015700059
VISIT DATE: 11/03/2021
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The Licensee’s Health and Safety training has been completed. Pediatric CPR & First Aid training has been completed for Licensee, her mother, and sister. All three expire 6/2023. Licensee’s Mandated Reporter has not been completed (see LIC9102-TV). All required forms are posted and visible for public view on the way by the front door. LPA obtained the children’s files and the facility roster. All files are complete. LPA obtained the fire/disaster drill log. Log is complete with last drill logged 8/04/2021. Licensee stated that her sister and herself transport children. LPA obtained their driver’s license, proof of insurance and registration for the vehicles. During the inspection LPA found that Licensee’s driver’s license was expired as of 11/03/2021. LPA gave Licensee assistance on how to renew her license (see LIC9102-TV).

Licensee was reminded that California Law requires 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 email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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 (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


Continued LIC809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, YSGLEE
FACILITY NUMBER: 015700059
VISIT DATE: 11/03/2021
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LPA discussed the safe sleep regulations with licensee 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 licensee of the importance of checking for recalled infant devices on 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Ysglee Rodriguez.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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