073409416-7-19-2023-02-CC-CWAS-CTVVFQ-20230719162419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409416
Report Date: 07/19/2023
Date Signed: 07/19/2023 04:24:25 PM

Document Has Been Signed on 07/19/2023 04:24 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:	CANADAS, ANDREA		FACILITY NUMBER:	073409416
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/19/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Andrea Canadas		TIME COMPLETED:	04:30 PM

NARRATIVE

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On 07/19/2023 at 1:20 PM, Licensing Program Analyst (LPA) Christina Watts conducted an announced Pre-licensing Inspection and met with Applicant, Andrea Canadas, who has applied for a Small Family Child Care Home with a capacity of eight (8). Living in the home are applicant, applicant's spouse and applicant minor child age 4. Only applicant was present during today's inspection. Days and hours of operation will be Monday – Friday from 7:00 AM - 5:00 PM.

Applicant completed 8 hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8 hour Pediatric CPR & First Aid Certificate that expires 01/2025, has documentation for Measles, Pertussis, and Influenza vaccine. Applicant and adults in the home has Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant has completed and submitted certificate for Mandated Reporter training which expires 05/2025. Applicant owns the home and has submitted documentation to licensing. LPA reminded applicant that when care for more than six and up to eight is provided, applicant must notify parents and provide parents form LIC 9150 - Parent Notification of Additional Children in Care. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents they do not carry a day care insurance. Applicant has a working telephone in the home.

This is a two story home that comprises of 4 bedrooms, 3 bathrooms, Living Room, Kitchen, Dining room, Laundry Room, Garage, Upstairs Loft and backyard.
Areas on limits: Living Room, kitchen, dining room, first floor bathroom, first floor bedroom, and backyard.
Off-Limit Areas: 3 bedrooms including master bedroom, 2 bathrooms, laundry room, upstairs loft and garage.
Isolation Area: Living room

*CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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: CANADAS, ANDREA	FACILITY NUMBER: 073409416
	VISIT DATE: 07/19/2023

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LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. There are stairs in the home that are made inaccessible to children. LPA observed fully charged 3A40BC fire extinguisher, working smoke, carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. Door access to off limit areas are made inaccessible to children. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Applicant states there are no firearms and ammunition stored in the home. Applicant stated there are no pets in the home.

Outdoor Space: LPA toured the outdoor area. LPA observed a fully fenced and safe backyard for children in care. LPA did not observed any bodies of water in the backyard. Children will be using the backyard and a park near the facility for outdoor activity. LPA discussed with applicant that there needs to be 100% supervision when outside of the facility. Applicant will provide transportation for children and understands that children cannot be left alone, unattended in parked vehicles

Applicant understands that children's personal rights should not be violated nor any corporal punishment. Isolation of sick children, 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 conducted once every six months and documented. A Family Child Care Home packet was provided to and reviewed with the Applicant.

LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Small Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

LPA reviewed with Applicant the LIC311D, Forms/Records To Keep In Your Family Child Care Home, Children's Forms/Records, Facility Forms/Records, and Information to be Posted.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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 *CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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: CANADAS, ANDREA	FACILITY NUMBER: 073409416
	VISIT DATE: 07/19/2023

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LPA discussed the safe sleep regulations with Applicant, 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 applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Website links for provider resources:

Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication or email:childcareadvocatesprogram@dss.ca.gov

Applicant's application for a small family child care home has been approved and will be licensed as of 07/19/2023. Exit interview was conducted with Applicant, Andrea Canadas and signed the report acknowledging receipts of documents.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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