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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407102
Report Date: 02/27/2023
Date Signed: 02/27/2023 12:24:59 PM

Document Has Been Signed on 02/27/2023 12:24 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:ROCHA, NORMAFACILITY NUMBER:
073407102
ADMINISTRATOR:ROCHA, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 679-0826
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 1DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Norma RochaTIME COMPLETED:
11:00 AM
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On 02/27/2023 at 8:45 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Norma Rocha's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 1 preschool aged child in care and 13 children enrolled. Licensee, licensee's spouse and licensee's father in law were home during the inspection. Family members residing in the home are licensee, licensee's husband, licensee's mother and father in law. Facility hours of operations are Monday - Friday from 6:30 AM - 6:30 PM.

This is a two story home which consists of 6 bedrooms, 4 bathrooms, kitchen, dining room, living room, family room, laundry room, attached garage, and backyard.
The children on limits areas: First floor hallway bathroom, Kitchen, Family Room, first floor hallway.
Areas off limits include: Entire second floor which includes 4 bedrooms, 2 bathrooms, 2 downstairs bedrooms, 1 downstairs bathroom, living room, dining room, laundry room, attached garage and backyard.
The LPA toured all areas used by children during this visit.

During tour of facility, licensee stated school children use dining area for homework. Currently, dining room is an off limits area. LPA reminded licensee they cannot use an off limit area of the home without prior inspection and approval of licensing. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

*CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ROCHA, NORMA
FACILITY NUMBER: 073407102
VISIT DATE: 02/27/2023
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*PAGE 2*

Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 3A40BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a screened fireplace in the family room. Licensee last conducted fire drill 12/21/2022. LPA observed two dogs in the facility however licensee stated there are four dogs in the facility.

Licensee stated she does not use the backyard for outdoor play. Licensee stated she uses park near facility for outdoor activity. LPA reminded licensee when outside of facility, 100% supervision of children in care is required. Facility does provide transportation for children, but understands that children cannot be left alone, unattended in parked vehicles

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensee Pediatric First Aid and CPR certificate will expire in 01/2024. LPA did not observed Emergency Disaster plan. Licensee stated she was updating the form and unable to find the form. LPA reminded licensee the importance and requirement of required posting for parents/authorized indvidual/licensing to view. Licensee stated she will update form and have form posted. All other required postings were observed near the entrance.

LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.



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-and-resources/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.

*CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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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: ROCHA, NORMA
FACILITY NUMBER: 073407102
VISIT DATE: 02/27/2023
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*PAGE 3*

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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee stated she completed Mandated Reporter on 02/21/2023 however has not received the certificate.


During record review, LPA discovered two adults living in the home who currently do not have criminal background clearance. Licensee stated that she makes sure that all adults living in the home have criminal background clearance. LPA reminded licensee of the importance and requirement of adults having clearance before living in the home. Licensee stated she will make sure both adults have fingerprint clearance. Licensee stated for the timing being, both adults must limit interaction with children prior to clearance. Licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

*CON'T ON PAGE 4*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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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: ROCHA, NORMA
FACILITY NUMBER: 073407102
VISIT DATE: 02/27/2023
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*PAGE 4*

LPA Christina Watts informed Norma Rocha that this report dated 02/27/2023 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.

Exit interview conducted and report was reviewed with the licensee, Norma Rocha. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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Document Has Been Signed on 02/27/2023 12:24 PM - It Cannot Be Edited


Created By: Christina Watts On 02/27/2023 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROCHA, NORMA
FACILITY NUMBER: 073407102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when two adults living in the home currently do not have criminal background clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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Licensee will have both adults retain a criminal background clearance.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above when licensee stated she uses off limit area for children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2023
Plan of Correction
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LPA updated off limit area - licenseee submitted update facility sketch.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023


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