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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404604
Report Date: 06/18/2021
Date Signed: 06/18/2021 01:41:22 PM

Document Has Been Signed on 06/18/2021 01:41 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MATUS, LINDAFACILITY NUMBER:
073404604
ADMINISTRATOR:MATUS, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 216-1341
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Linda MatusTIME COMPLETED:
01:50 PM
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On 6/18/21 at 11:50am, Licensing Program Manager Loretta Dyson arrived at the home for an unannounced 1 year required inspection. LPM met with the licensee. There was 1 preschool age child, 2 infants, and the licensee's fingerprint cleared adult daughter also present. LPM toured the areas of the home that are used for the child care with the licensee, to conduct a health and safety inspection.

The home is a single story home which consists of the living room, dining area, kitchen, 4 bedrooms, 2 bathrooms and the garage. The on limit areas include the living room, dining area, kitchen, the first bedroom on the right (nap room), the first bedroom on the left (play room) and the bathroom at the end of the hallway. The off limit areas are the licensee's bedroom, her daughter's bedroom, master bathroom, garage and backyard. These areas are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be the first bedroom on right (nap room), away from other children in care. LPM observed that the home is neat and clean with sufficient heating and ventilation for the safety and comfort of children in care. The outdoor play area is the front yard, which is fully fenced and free from defects or dangerous conditions. There are an ample supply of age appropriate toys and activities, both indoors and outdoors, which appear to be safe and in good condition. LPM did not observe any bodies of water, hazardous items, toxins, or medications accessible to children today. LPM did not observe any child left in a parked vehicle.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked first aid kit. The licensee's CPR and First Aid certificate is current and expires in March 2022. The licensee's mandated reporter training certificate expires on 1/25/22. The fireplace is blocked to prevent access by children. Per licensee, there are no firearms in the home.

**************************************************************************continued on 809C
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MATUS, LINDA
FACILITY NUMBER: 073404604
VISIT DATE: 06/18/2021
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At 12:27pm, LPM began review of 3 children's files, and found them to be in compliance with the Title 22 regulations. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. 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.htmThe licensee stated that there are no children enrolled at this time, who require medication while in care.

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. LPM reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com. LPM reviewed reporting requirements for unusual incidents and injuries requiring medical attention.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. LPM discussed the new safe sleep regulations, and provided a copy of the Individual Infant Sleeping Plan form (LIC 9227) to the licensee.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted and appeal rights were provided.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
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