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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409190
Report Date: 03/17/2023
Date Signed: 03/17/2023 12:33:36 PM

Document Has Been Signed on 03/17/2023 12:33 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:RUBIO, MARIAFACILITY NUMBER:
073409190
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Enoelia FloresTIME COMPLETED:
12:45 PM
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On 3/17/23 at 10:45am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Required Annual Inspection at Maria Rubio's Family Child Care Home. At first no one came to the door. LPA called and left a voicemail for Licensee. Door to the home was unlocked and LPA observed children inside. After several minutes Helper, Enoelia Flores came to the door. Enoelia stated Licensee, Maria had a medical appointment and was not present at home. LPA explained the purpose of today’s inspection and was granted permission to enter the facility. Present in the home were 6 day care children (3 infants, 3 preschool age) with Helper. Facility is in compliance with required ratios today.
LPA toured the INDOOR spaces of the home which is a single floor home.
IN USE AREAS: Entry area near kitchen, Play room, Living/Dining space, 1 bedroom for naps (middle room), Bathroom in hallway, Kitchen.
OFF LIMITS: 2 bedrooms, Renters' residences (two separate in-law units), Detached garage, 3 outdoor storage sheds
LPA observed 2 infants napping in the middle nap room. Hallway door leading to the bedroom and bedroom door were closed. There was a blanket in one crib in which an infant was sleeping. Helper stated she checks infants every 15 minutes but was unaware of the Sleep Log. There were sufficient materials, toys, and play equipment for the day care children in the home. Children were engaged in various activities under the supervision of Helper. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers, jumpers or bouncers observed on the premises. The home is sanitary, orderly, and safe for the day care children. LPA observed a fully charged fire extinguisher and working smoke / carbon monoxide detectors. Licensee has a pet cat. All required postings were observed posted on a wall.
OUTDOOR space was inspected. Children use the far end of the backyard for outdoor activity. They walk through the pathway between the renter's unit on left and detached garage on right side; through the gate, into the play yard. The yard is fenced on all sides. No bodies of water were observed. 3 Storage sheds are locked.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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: RUBIO, MARIA
FACILITY NUMBER: 073409190
VISIT DATE: 03/17/2023
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 FILE REVIEW: Children, Helper files were reviewed. Helper has background clearances and valid CPR/First Aid.

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.

LPA provided information on Safe Sleep regulations 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.

In the areas that were evaluated, regulatory violations were observed. Citations are issued on 809-D pages of this report. Exit interview conducted and report was reviewed with Helper, Enoelia Flores. Staff interview was not conducted. Licensee had not arrived at time of exit interview. A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
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Document Has Been Signed on 03/17/2023 12:33 PM - It Cannot Be Edited


Created By: Monica Mathur On 03/17/2023 at 12:18 PM
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: RUBIO, MARIA
FACILITY NUMBER: 073409190

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed an infant napping in the crib with a blanket by the side. Helper removed the blanket during inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2023
Plan of Correction
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By POC Due Date 3/20/23 Licensee shall send a written plan on how facility will stay in compliance with above regulation and her understanding of safe sleep requirements.
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed 2 doors leading into the nap room were closed shut. Helper was in the play room with other children while 2 infants were napping in the room. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2023
Plan of Correction
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By POC Due Date 3/20/23 Licensee shall send a written plan on how facility will stay in compliance with above regulation and her understanding of safe sleep requirements.
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:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


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