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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700345
Report Date: 07/20/2022
Date Signed: 07/20/2022 09:30:01 AM

Document Has Been Signed on 07/20/2022 09:30 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:YEPEZ, DANIELFACILITY NUMBER:
015700345
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/20/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:DANIEL YEPEZTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Sidney Cortez conducted an inspection with applicant Daniel Yepez. The purpose of this inspection was to conduct an Announced Pre Licensing Inspection. Applicant plans to operate the facility Monday through Friday from 6:00am until 6:00pm. Present for this visit is the applicant. The home was toured to conduct a Health and Safety Inspection.

The home is 1 story. The home consists of 4 bedrooms, 2 bathroom, living room, dining room, kitchen, backyard and garage There is no pool or any type of bodies of water in the home. Per applicant, there is no fire-arm in the house. The home is neat and clean with heating and ventilation for safety and comfort.
The OFF LIMIT AREAS is the 3 bedrooms, one bathroom (inside the master bedroom) and the garage.
The ON LIMIT AREAS are the living room, dining room, family room, bathroom (hallway), and one bedroom for the infants; and the backyard. The ISOLATION AREA is the living room area–near the entrance, so its easier for parents to pick up the child. There are toys and learning materials in the activity room area. Hazardous materials and toxins are kept out of the reach of children and it was observed that there would be no toxins or hazardous items accessible to children during today's inspection.
The home has one fully charged fire extinguisher (model 3A40BC), and working smoke/carbon monoxide detectors, first aid kit, emergency supplies, and working telephone. The applicant’s Health and Safety training is completed, and licensee’s CPR and First Aid certificates are current and both certificates will expire on Feb 2024. Licensee has also has a certificate for the Lead Poisoning Training completed in Jan 2021.
The applicant is in compliance with new immunization law. Applicant received a certificate in mandated reporter training on 2/21/2022 which is valid for 2 years. A Property Owner/Landlord Notification of the property was given by the applicants.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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: YEPEZ, DANIEL
FACILITY NUMBER: 015700345
VISIT DATE: 07/20/2022
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Licensee is 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

LPA Cortez provided a copy of Safe Sleep-in child care brochure, a handout "What Does A Safe Sleep Environment Look Like," and a copy of the new California Car Seat Law Changes. The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

This home is recommended for licensing. This report shall remain on file for 3 years. Exit interview conducted with licensee.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
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