073409139-3-22-2021-02-CC-MMAR-BZCRY6-20210322132550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409139
Report Date: 03/22/2021
Date Signed: 03/22/2021 01:26:04 PM

Document Has Been Signed on 03/22/2021 01:26 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:	CAMACHO, GENESIS		FACILITY NUMBER:	073409139
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/22/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Genesis Camacho		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/22/2021 Licensing Program Analysts (LPAs), Monica Mathur and Michelle Sutton conducted an announced Pre-licensing Inspection at Genesis Camacho's home and met with Applicant, Genesis who has applied for a Small Family Child Care Home with a capacity of eight (8). Days and hours of operation will be Monday through Friday from 7:30 AM to 4:30 PM. There are 2 adults residing in the home: Applicant and her partner. There is 1 child (step daughter, age 7) under age of 18 years living in the home. Applicant completed the 16-hour Preventative Health training which includes EMSA approved pediatric cardiopulmonary resuscitation and first aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, Influenza vaccination (opt-out) for the current flu season. Applicant and adult living in the home have Criminal Record and Child abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant rents the home and has submitted a copy of the Rental Agreement to CCLD. LPA reminded Applicant that when care for more than six and up to eight is provided, Applicant must notify parents and obtain landlord consent. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents that she does not carry a day care insurance. Applicant has a working telephone in the home. Indoor Space: LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. In-Use Areas are: Living room, Kitchen, Play room, Bathroom, Laundry room and Backyard Off-Limit areas are: Master bedroom and Bedroom 1. There are no stairs or fireplace in the home. A closet in the Play Room has children supplies stored. LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector in Living room and Play room. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches and locks. There are 2 open face heaters, one in the Living room and 1 in the Play room. LPA advised that both be screened and made inaccessible. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Applicant states that there are no pets or arms and ammunition stored in the home. CONTINUED ON NEXT PAGE 2 - 809-C

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: CAMACHO, GENESIS	FACILITY NUMBER: 073409139
	VISIT DATE: 03/22/2021

NARRATIVE

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Outdoor Space: LPA toured the outdoor area (back space) and observed it was fenced. Children will walk through the Laundry room to access the back yard. LPAs observed child proof gates cordoning off the washer, dryer and water heater in the Laundry room. No bodies of water were observed outside. Utility shut off are located near the backyard gate which leads to the outside private parking lot. Shut offs are barricaded by child proof gates and side gate has a latch which is out of reach from children.

Discipline policy was discussed, and Applicant stated she will talk to the children and use "quiet time" as form of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children (in the kitchen), supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced once every six months and documented. A Family Child Care Home packet was provided to and reviewed with the applicant.

LPA discussed Individual Medical Services (IMS) policy. Applicant does not plan on providing Individual Medical Services (IMS) at this time. 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.

LPA reminded applicant of the applicable $100 civil penalty per person per day, a minimum of $100.00 to a maximum of $3000.00 per person for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: CAMACHO, GENESIS	FACILITY NUMBER: 073409139
	VISIT DATE: 03/22/2021

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LPA discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. AB 633 was discussed with Applicant. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.
Website links for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

Email to: childcareadvocatesprogram@dss.ca.gov

The following improvements to be completed prior to licensure of a small family child care home:

1. There are 2 open face heaters, one in the Living room and 1 in the Play room. LPA advised that both be screend and made inaccessible. Applicant agreed to send pictures as proof.

LPA provided a Family Child Care Home packet with copies of all required forms and documents needed for starting the day care. LPA also reviewed all the forms with the Applicant.

Exit interview was conducted with Applicant and she was informed that a License to operate a Small Family Child Care Home will be approved after completion of improvements as advised during inspection. Applicant signed the report acknowledging receipts of documents.

END OF REPORT

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC809 (FAS) - (06/04)

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