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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408732
Report Date: 08/11/2021
Date Signed: 08/11/2021 11:38:12 AM

Document Has Been Signed on 08/11/2021 11:38 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:LIMA, PATRICIAFACILITY NUMBER:
073408732
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Patricia LimaTIME COMPLETED:
12:50 PM
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On August 11, 2021, Licensing Program Analyst (LPA) Caroline Colson met today with Patricia Lima for an unannounced case management inspection to go from being on Inactive Status to being on Active Status at 9:57 AM. There were no day care children present. The facility's operating hours are Monday - Friday from 7:45 AM to 5:30 PM. LPA toured the facility for a health and safety inspection.

The home is a one story home. The home consists of one kitchen with dinning area, 3 bedrooms, 2 bathrooms, a deck, fenced back yard, fenced side yard, fenced carport, fenced front yard and garage. The home has heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the 3 bedrooms, 1 bathroom located near the bedrooms, fenced side yard, deck, fenced back yard and garage. Off Limit Areas are made inaccessible by closed and/or locked doors and gates. The ISOLATION AREA will be located in the living room. The outdoor play area will be the fenced carport which is completely fenced. There is an ample amount of toys available. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. Per Patricia Lima, 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. Emergency Disaster Plan is current and posted. Licensee has current CPR and First Aid Training certificates which expire on June 28, 2023. Licensee submitted the COVID-19 Self-Assessment Guide and a review was conducted. Posters and additional resources was sent to the licensee prior to the inspection.

Please See LIC 809 C for additional information.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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: LIMA, PATRICIA
FACILITY NUMBER: 073408732
VISIT DATE: 08/11/2021
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A copy of the lease agreement was reviewed and shows control of property.

Applicant 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov


· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

Incidental Medical Services (IMS) policy was discussed.

Licensee will need to submit both classes for the Mandated Reporter Training before being Active.

An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
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