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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407353
Report Date: 05/25/2022
Date Signed: 05/25/2022 11:27:08 AM

Document Has Been Signed on 05/25/2022 11:27 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CHIPRES, MARIA LOURDESFACILITY NUMBER:
073407353
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Lourdes ChipresTIME COMPLETED:
11:45 AM
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On May 25, 2022 at 9:30 AM, Licensing Program Analyst (LPA) Nyeesha Blount and Melissa Domantay met with Licensee Maria Lourdes, Chipres and Assistant Erika Romero for an unannounced random annual inspection. There is one Infant and 1 preschool children present. The facility's operating hours are Monday, Wednesday, Friday from 6:00 AM to 10:00 PM, Tuesday and Thursday hours are from 6:00 AM to 6:00 PM LPA toured the facility for a health and safety inspection.


Indoor Space: The downstairs childcare room and downstairs bathroom. all other areas are off limits to children in care. off limit areas are made inaccessible by closed doors. there is a closed door at the base of the stairs. The home has central heating and ventilation for safety and comfort. There is an ample amount of toys available. Licensee states that there are no weapons in the home. All hazardous materials and toxins are stored away from children. The home is equipped with a 2A10BC fire extinguisher, working smoke detector and working carbon monoxide detector. All required documents are posted. Pediatric CPR and First Aid are current and expire on January, 2023.

Outdoor Space: The back patio is fully fenced and on limits to children in care with adult supervision present at all times. the hillside areas of the outdoor area are off limits to children in care. The entire area was inspected to ensure the health and safety of the area. There are no pools, hot tubs or any other bodies of water on the premises.

Off Limit Areas: The three main bedrooms, main bathroom, second bathroom, kitchen, living room, dining room..

Please See LIC 809 C for additional information.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CHIPRES, MARIA LOURDES
FACILITY NUMBER: 073407353
VISIT DATE: 05/25/2022
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LPA'S reviewed the facility, staff and children's records including parents' rights forms, emergency ID forms and consent for emergency medical treatment forms. Licensee CPR/First Aid, Mandated Reporter Certificate for Licensee is all up to date.

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. there are no firearms stored or present in the home.


Per 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

Licensee was reminded that all adults 18 and over living or working in the home, 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.


Licensee was reminded about importance to stay in compliance with mandated reporter training and maintenance of sleep logs for all infants in care. In the areas that were evaluated, no regulatory violations were observed.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the licensee Chipres, Maria, Lourdes.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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