015700059-12-11-2023-52-CC-MPRE-CYEUP2-20231211144448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700059
Report Date: 12/11/2023
Date Signed: 12/11/2023 02:45:01 PM

Document Has Been Signed on 12/11/2023 02:45 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, YSGLEE		FACILITY NUMBER:	015700059
ADMINISTRATOR:	RODRIGUEZ, YSGLEE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 938-3779
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 20	CENSUS: 8	DATE:	12/11/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ysglee Rodriguez		TIME COMPLETED:	02:42 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 12/11/2023 at 10:30am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Ysglee Rodriguez for a Required – 3 Year Inspection. Present during the inspection was the Licensee, her sister Yolanda Amaya who serves as her helper, her mother, Isabelia Rosa Delgado de Rodriguez who serves as a helper, four (4) infants and three (3) preschool age children. One (1) more preschool age child arrived at 11:10am. Licensee lives in the home with her two sons, age twelve (12) and ten (10) her mother and her sister Yolanda Amaya. The facility operates 24 hours, Monday - Friday. Licensee is apart of We Care Services for Children. ON LIMITS AREA: Entire 2^nd Floor (Family Room, Living Room, Dining Room, Kitchen, Bedroom, Bathroom) and Backyard and Gated Top Portion Area of the Driveway in front of the House OFF LIMITS AREA: 1^st Floor Garage, Laundry Room (Across from Bedroom), and 3^rd Floor ISOLATION AREA: 2^nd Floor Bedroom or Living Room License has requested to use a gated cemented area at the top of the driveway as an on-limit area. The portion of driveway that will be used is at the top of the driveway, away from the street and gated. LPA granted the request and informed Licensee that full adult supervision will be required when using the space. LPA also informed Licensee that the gate should remained closed when children are present. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: RODRIGUEZ, YSGLEE	FACILITY NUMBER: 015700059
	VISIT DATE: 12/11/2023

NARRATIVE

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The facility is a three (3) story home rented by the Licensee. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Licensee uses highchairs, feeding chairs and child sized tables for mealtimes. All materials used for eating was observed to be clean and free from defects. LPA observed six (6) cribs in the home that is used for sleeping. All children’s bedding was observed to be clean and properly stored as well. All off limit areas are made inaccessible with gates, locks, and closed doors. Licensee stated they do transport children from local elementary schools. There are no pets and no firearms in the home.

The home has one (1) fully charged 3A40BC fire extinguisher on the kitchen counter next to the refrigerator. There is one (1) working smoke/carbon monoxide detector in the hallway next to the dining area, the bedroom, and in the hallway outside of the bedroom. The electric fireplace in the family room is blocked by furniture making it inaccessible to the children in care. The staircases leading to the first-floor garage and the third floor of the home are gated making the staircase and the first and third floor inaccessible to the children in care. The home is equipped with central heat and air for proper ventilation.

The backyard is fully fenced with ample age-appropriate materials for the children. There is a large wooden play structure with a swing and slide that has been anchored into the ground. LPA did not observe any harmful bodies of water in or around the home. The top of the backyard is on a slope and is off limit to the children in care.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid has been complete and expires 7/1/2025. Licensee’s two (2) helpers have current pediatric CPR & First Aid training as well. Licensee’s Mandated Reporter training has been partially completed. Licensee began the training during LPA's visit to obtain proof of completion. Fire/disaster drills have been conducted and documented, with the last drill logged on 8/30/2023. All required forms are posted and visible for view by the front door of the home. All adults living and working in the home have obtained a criminal record clearance. LPA obtained a sample of the children’s files, the facility files and the helper’s file. All files were complete.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

Page: 2 of 9

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: 12/11/2023

NARRATIVE

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No deficiencies were cited during this inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

Page: 3 of 9

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: 12/11/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Ysglee Rodriguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Ysglee Rodriguez.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

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