015700259-1-26-2022-52-CC-SKAR-CB2VDS-20220126152114

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700259
Report Date: 01/26/2022
Date Signed: 01/26/2022 03:21:28 PM

Document Has Been Signed on 01/26/2022 03:21 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:	MARCISCANO-BETTIS, RAIZA		FACILITY NUMBER:	015700259
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/26/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Raiza Marciscano-Bettis		TIME COMPLETED:	03:30 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 January 26, at 9:40am, Licensing Program Analyst (LPA) Simerjit Kaur arrived for an announced pre-licensing inspection, and met with the applicant Raiza Marciscano-Bettis. The home was toured with the applicant to conduct a health and safety inspection. Also present during the inspection is applicant's husband Martin Bettis. Applicant states the hours of operation for day care are Monday through Friday, 7:00am to 6:00pm. The home is two story and consists of a kitchen, living room, three bedrooms, two bathrooms, half bathroom, laundry room, office, converted garage, basement, backyard, storage and work shop. The converted garage (day care room) is neat and clean with heating and ventilation for safety and comfort. The areas that are accessible (on limit) to children are: the converted garage (day care room), bathroom located next main entrance door, and backyard. The isolation area will be in the corner of day care room. The areas that are inaccessible (off limit) to children are: the kitchen, living room, two bedrooms, two bathrooms, office, basement, laundry room, entire second floor. The off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing Department, so that an inspection can be completed prior to changing an off-limits area to on-limits. Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARCISCANO-BETTIS, RAIZA	FACILITY NUMBER: 015700259
	VISIT DATE: 01/26/2022

NARRATIVE

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The outdoor play area will be the backyard, which has a fence surrounding the perimeter of the yard, and is free from defects. The applicant was advised to provide 100% supervision at all times, when children are outdoors. The applicant was advised to ensure that the front and back gate of the yard remains closed while children are outdoors. There is pool and a hot tub, which are securely covered during the inspection today. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector (installed automatic fire sprinklers in ceiling) which are located in converted garage (day care room) and first aid kit. Per applicant, there are no firearms in the home.

The applicant’s health and safety training has been completed, and pediatric CPR/First Aid is current, expiring on 2/20/23. A copy grant deed has been reviewed and shows control of property. The applicant has provided proof of the immunizations required for day care providers. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed, and copies were left with the applicant. Safe Sleep regulations were discussed, and new car seat laws were provided. Applicant was reminded that children are never to be left in a parked vehicle.

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 on LIC 809C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARCISCANO-BETTIS, RAIZA	FACILITY NUMBER: 015700259
	VISIT DATE: 01/26/2022

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The applicant was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Effective August 1, 2003 California Law requires Family Child Care Home 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented. Mandated reporter requirements also discussed. Applicant received copies of various pamphlets pertaining to child's safety and parent's responsibilities. Informed the applicant that all forms can be downloaded at www.ccld.ca.gov.

The applicant was advised to make the following corrections prior to licensing the home:

Mandated Reporter Training Certificate
Secure 2 rolling shelves in day care room
Secure rolling storage cabinet located next to sink in the day care room.
Secure coverage of pipes and electrical equipment next to pool in backyard.

Exit interview conducted with Raiza Marciscano-Bettis. Copy of report provided.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC809 (FAS) - (06/04)

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