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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409463
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:02:55 PM

Document Has Been Signed on 12/07/2023 12:02 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:RODRIGUEZ, PATRICIAFACILITY NUMBER:
073409463
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Patricia RodriguezTIME COMPLETED:
12:10 PM
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On December 7, 2023 at 9:15am, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced prelicensing inspection. LPA met with applicant Patricia Rodriguez. Present for the inspection were the applicant and her fingerprint cleared husband. The applicant plans to operate Monday-Friday 7am-6pm. LPA verified the applicant's phone number and email on record are correct.

LPA toured the home with the applicant, to conduct a health and safety inspection. LPA observed that it is neat and clean with heating and ventilation for the safety and comfort of children. The home is a single story home consisting of the living room, dining room, kitchen, family room with attached bathroom, three bedrooms, hallway bathroom, a fully fenced in backyard, laundry room, a tuff shed and two small storage sheds used for storage.

The Off Limit Areas are all three bedrooms, hallway bathroom, kitchen, dining room, living room, laundry room, backyard. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.

The On Limit Areas are the family room and attached bathroom.

Isolation Area - on the couch in the family room

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today. The applicant stated there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher, working combination smoke and carbon monoxide detector, and working telephone. The applicant completed the preventative health and safety training which includes 1 hour of nutrition and lead component and the ****************************************Page 1 of 3**************************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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: RODRIGUEZ, PATRICIA
FACILITY NUMBER: 073409463
VISIT DATE: 12/07/2023
NARRATIVE
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CPR and First Aid training which expires on July 2025. The Applicant has a current Mandated Reporter Certificate. LPA reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children, and left copies with the applicant. LPA advised the applicant of where to obtain additional copies of the forms. The applicant stated that she will have documents posted right outside of the front door. LPA reminded the applicant that the required documents must be visible for the public at all times during hours of operation. The applicant provided a rental agreement as proof of property control.. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPA reviewed children's personal rights and the applicant advised that she understands that children's personal rights should not be violated and no corporal punishment. LPA reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reviewed fire/earthquake drill information, and how to complete the drill log. LPM demonstrated how to fill out the immunization record for children's files, discussed the applicant's responsibility to ensure the records are up to date and have discussions with parents/guardians if they are not, and advised that it does not need to be done if children are enrolled in school. LPM reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPM reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

LPA verified that the applicant, and all other adults living in the home, have a criminal record clearance and are associated to the license. 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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)


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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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: RODRIGUEZ, PATRICIA
FACILITY NUMBER: 073409463
VISIT DATE: 12/07/2023
NARRATIVE
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514-0301 (voice) or (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 discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPM 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.

On December 7, 2023 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The License for a small Family daycare has been granted and is active as of today December 7, 2023.


Exit interview conducted.
Report reviewed and provided to Licensee Patricia Ramirez.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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