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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409275
Report Date: 08/04/2022
Date Signed: 08/05/2022 09:40:13 AM

Document Has Been Signed on 08/05/2022 09:40 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:QUINTEROS, IRMAFACILITY NUMBER:
073409275
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/04/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Irma QuinterosTIME COMPLETED:
01:05 PM
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On Thursday, August 4, 2022 at 10:29 AM Licensing Program Analyst (LPA) Caroline Colson met with Irma Quinteros, her teenage niece and her young daughter for an announced prelicensing and technical assistance inspection. There are no day care children present. The home was toured to conduct a health and safety inspection. All required forms were reviewed and given during the inspection. Operating Hours are Monday - Friday 7:00 AM - 6:00 PM

Indoor Space: The home is a two story home. The home consist of three upstairs bedrooms, upstairs master bathroom, a second upstairs bathroom, downstairs bathroom which includes washer/dryer, locked hallway closet, living room, dinning area, kitchen with seating area, partial fenced side yard next to driveway, split garage with added room, two locked fenced side entrances which both leads to the large fenced back yard with a shed. There is a working smoke detector and a carbon monoxide detector. Mrs. Quinteros states that there are no firearms in the home. She sent a copy of her mortgage statement for the home. There are toys available for the children. Her CPR and First Aid certificates are current and expire on March 1, 2024. Her Mandated Reporter Training certificate is current and expire on March 24, 2024. There is a First Aid Kit available. The isolation area will be the dinning area. There are no pets.

Outdoor Space: The fenced back yard is the outdoor play space.

Off Limit Areas: All three upstairs bedrooms, upstairs master bathroom, second upstairs bedroom, split garage with added room, kitchen, hallway closet, shed, driveway and partial fenced side yard.


Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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: QUINTEROS, IRMA
FACILITY NUMBER: 073409275
VISIT DATE: 08/04/2022
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The following items need to be corrected by September 4, 2022:

1. Applicant needs to ensure the home has heat.
2. Applicant needs to purchase a 2A10BC or larger fire extinguisher.
3. Applicant needs to lock the split garage with the room attached.
4. Applicant needs to post Emergency Disaster Plan.



REMINDERS/RESOURCES

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

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. 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 ADA, available at: http://www.ada.gov/childquanda.htm


Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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: QUINTEROS, IRMA
FACILITY NUMBER: 073409275
VISIT DATE: 08/04/2022
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Family Child Care Homes

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.

Safe Sleep

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Irma Quinteros 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.

Notice of Site Visit

A notice of site visit was given and must remain posted for 30 days.

Exit Interview

Exit interview conducted and report was reviewed with the applicant, Irma Quinteros.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
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