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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408376
Report Date: 07/22/2022
Date Signed: 07/22/2022 11:25:58 AM

Document Has Been Signed on 07/22/2022 11:25 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:GUZMAN, ADRIANAFACILITY NUMBER:
073408376
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:GUZMAN, ADRIANTIME COMPLETED:
11:45 AM
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On July 15, 2022 at 9:45 AM, Licensing Program Analyst (LPA) Nyeesha Blount met with Licensee Adriana Guzman for an unannounced random annual inspection. There are (4) preschool children present. The facility's operating hours are Monday - Friday from 6:00 AM to 6:00 PM LPA toured all on limit areas of the facility for a health and safety inspection, all required postings are posted in the entry way of the home on the wall.

Indoor Space: The home is a two story home. The home consists of one kitchen ,living room, dining room, four (4) bedrooms, (2) bathrooms, fenced back yard, front yard and garage which is converted into children's play room. The home is neat and clean and has central heating and ventilation for safety and comfort. There is ample amount of age appropriate toys, books available. Licensee states that there are no weapons in the home. All hazardous materials and toxins are stored away inaccessible to children in care. The home is equipped with a 2A10BC fire extinguisher, working smoke detector and working carbon monoxide detector. Pediatric CPR and First Aid are current and will expire on July 2022 .


Outdoor Space: The fenced back yard is the outdoor play space. The entire area was inspected to ensure the health and safety of the area. all play structures are properly secured clean and in good condition There are no pools, hot tubs or any other bodies of water on the premises. Inspection was conducted through translation on telephone to ensure understanding.

Off Limit Areas: Second Story, two bedrooms, one bathroom are the off limit areas.
Isolation Area : will be the first bedroom sleeping room to the right of the hallway.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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: GUZMAN, ADRIANA
FACILITY NUMBER: 073408376
VISIT DATE: 07/22/2022
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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.

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

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

.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

In the areas that were evaluated, no regulatory violations were observed, Technical Violation was given for not having a current Mandated Reporter's Training present during inspection. A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the licensee Guzman, Adriana..
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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