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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700344
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:14:24 PM

Document Has Been Signed on 09/01/2022 02:14 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, YSABELFACILITY NUMBER:
015700344
ADMINISTRATOR:YSABEL RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 677-4778
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ysabel RodriguezTIME COMPLETED:
02:45 PM
NARRATIVE
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On September 1, 2022, at 11:45 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an announced Pre-licensing Inspection and met with applicant,Ysabel Rodriguez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. There were no children present during this inspection. The facility was toured to conduct a health and safety inspection. The facility plans to operate between the hours of 8:30 AM-5:30 PM, Monday -Friday

This single story home, which is neat and clean with heating and ventilation for safety and comfort. The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be a section of the living room, away from other children in care.

On-limit-areas are the: Living and dining room, bedroom (3), kitchen, and bathroom

Off-limit-areas are : Bedroom (1) and bedroom (2), laundry area, backyard, and garage

The home has a fully charged 3A40BC fire extinguisher, wired smoke detector and carbon monoxide detector, and telephone. There's no fireplace or heaters in the home and the home has central heating.

There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

There's no outdoor play area at this time. For outdoor activities, the applicant states that she would utilizes the school and park next door for the children's play area and the applicant is reminded to have 100% supervision at all times while away from the facility.

See 809-Continuation
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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 3
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, YSABEL
FACILITY NUMBER: 015700344
VISIT DATE: 09/01/2022
NARRATIVE
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Per licensee, there are no firearms in the home. The applicant in compliance with the immunization laws which pertains to all childcare providers.

A copy of the rental agreement was reviewed and shows control of property. The applicant completed and received a certificate in mandated reporter training on 08/17/2022. Applicant's CPR and First Aid certificate is current and expires 06/2023.

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: http://www.ada.gov/childqanda.htm

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 platform.

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. The licensee was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com. CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

LPA discussed the safe sleep regulations with 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 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

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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: RODRIGUEZ, YSABEL
FACILITY NUMBER: 015700344
VISIT DATE: 09/01/2022
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Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

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.

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

Entrance Checklist was provided to the applicant.

Exit interview conducted and report was reviewed with the applicant, Ysabel Rodriguez. This home is recommended for Licensure on 09/1/2022.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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