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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405385
Report Date: 06/06/2024
Date Signed: 06/06/2024 02:44:22 PM

Document Has Been Signed on 06/06/2024 02:44 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:RIVERA, IRMAFACILITY NUMBER:
073405385
ADMINISTRATOR/
DIRECTOR:		RIVERA, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 439-1471
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Irman RiveraTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 6/6/2024, at 12:10 pm Licensing Program Analyst (LPA) Brindha Govindasamy and Licensing Program Manager (LPM) Sherelle Johnson conducted an unannounced Annual Inspection at Irma Rivera’s Large Family Childcare Home. LPA met with licensee Irma Rivera and explained the purpose of today’s inspection. LPA and LPM was granted inspection authority to enter the home. Present in the home at the time of inspection were licensee, licensee’s spouse, fingerprinted adult son, minor child (11 years), 2 infants and 6 preschool children and 3 school age children in care. Licensee has 01 pet dog in the house. This family childcare home operates Monday to Friday, 7:00 am to 6:00 pm. Licensee is reminded if there is an additional helper under the age 18 is present during summertime, all vaccination is required and cannot be be left alone with children.

LPA toured the home with licensee to conduct a health and safety inspection. The home is a single-story home, consists of 4 bedrooms, 2 bathrooms, living room, kitchen, dining room, family room, backyard, and garage. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care.

On Limit Areas: Living Room, Bedroom 1/Office, Family Room, Dining Room, Kitchen, and Hall bathroom.
Off Limits Areas: Master Bedroom, Master Bathroom, Bedroom 2, Bedroom 3 and Garage.
Outdoor Areas: Backyard ( Fully Fenced with play structure)
Isolation Area: End of Hallway
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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RIVERA, IRMA
FACILITY NUMBER: 073405385
VISIT DATE: 06/06/2024
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Off Limits areas are made inaccessible by closed and/or locked doors, gates, latches, and visual supervision. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and drawers with latches. There is a faux fireplace in the living room. LPA observed age-appropriate toys, equipment, and activities available for children both indoors and outdoors and observed that they are in good condition. LPA observed backyard was fully fenced with play structure. LPA did not observe any bodies of water, toxins, medications, or hazardous items that would be accessible to children. Licensee stated that there are no firearms on the premises.

The home is equipped with fully charged 3A40BC fire extinguisher, a working carbon monoxide detector, working smoke detector and working telephone. Licensee has proof of current CPR/First aid certificates, which expires on 2/10/2026. Licensee’s Mandated Reporter Expires on 9/15/2024 and Spouse's 5/30/2026. The last documented fire drill was conducted on 4/8/2024. LPA observed all the required forms posted. LPA reviewed children's files, staff files and obtained a copy of the current roster. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers, and similar items are NOT allowed in family childcare homes.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Continue to Page 3

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RIVERA, IRMA
FACILITY NUMBER: 073405385
VISIT DATE: 06/06/2024
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LPA discussed the safe sleep regulations with licensee 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 licensee 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 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.


Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Irma Rivera was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Irma Rivera confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Website Resources: Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.

Technical Advisories was discussed. There were no deficiencies cited during today’s visit. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided and discussed.

Exit interview conducted and report was reviewed with the licensee Irma Rivera.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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