015701076-2-14-2024-52-CC-BPLY-D2FR38-20240214113932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015701076
Report Date: 02/14/2024
Date Signed: 02/14/2024 11:39:40 AM

Document Has Been Signed on 02/14/2024 11:39 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA		FACILITY NUMBER:	015701076
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/14/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Susana Ibanez Olvera and Maria Olvera Dominguez		TIME COMPLETED:	11:50 AM

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 2/14/24, Licensing Program Analyst Briana Plumboy, met with applicants Susana Ibanez Olvera and Maria Olvera Dominguez for an ANNOUNCED PRE LICENSING INSPECTION. Present for this visit was both applicants and fingerprint clear and associated adult A. Ibanez Castro. The home was toured to conduct a Health and Safety Inspection. The applicants plan to operate the facility Monday through Friday from 6:00am until 6:00pm. The home is single story. The home consists of 3 bedrooms, 1 bathroom located in one of the bedrooms, a hallway bathroom, living room, kitchen, dining room, and studio located in the backyard (the studio has a bathroom). The home is neat and clean with heating and ventilation for safety and comfort during today's inspection. The OFF LIMIT AREAS are the first bedroom located on the left side of the hallway, the bedroom located at the end of the hallway, the entire studio, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the kitchen, living room, dining room, hallway bathroom, and bedroom located on the right side of the hallway. The ISOLATION AREA will be in the living room or dining room depending on the activity occuring. Outdoor play area will be in the backyard including on the deck. There are toys and and learning materials present during the inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items which could be accessible to children in care. The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Both applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 12/2/25. The applicants completed and received certificates in mandated reporter training. Susana Ibanez Olvera completed hers on 11/9/23, and Maria Olvera Dominguez completed her training on 12/1/23. The applicants are in compliance with the immunization law which pertains to day care providers. The fireplace is electric, controlled by a remote and located in the living room. It has a screen to prevent access by children. Per applicants, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property by Susana Ibanez Olvera and Maria Olvera Dominguez. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA	FACILITY NUMBER: 015701076
	VISIT DATE: 02/14/2024

NARRATIVE

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The applicants are reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The applicants were also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

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

Applicants are 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

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA	FACILITY NUMBER: 015701076
	VISIT DATE: 02/14/2024

NARRATIVE

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Applicants are aware they should have knowledge of all Title 22 Regulations prior to accepting children into care and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Family Child Care Homes Applicants were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the applicants Susana Ibanez Olvera and Maria Olvera Dominguez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Entrance Checklist was provided to applicants.

LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed 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-carelicensing/subscribe and select the Child Care option to receive email communication.

This home is recommended for licensing on 2/14/24. This report shall remain on file for 3 years. Exit interview conducted.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC809 (FAS) - (06/04)

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